Power Nicholas E, Kassouf Wassim, Bell David, Aprikian Armen G, Fradet Yves, Lacombe Louis, Chin Joseph, Izawa Jonathan, Estey Eric, Fairey Adrian, Cagiannos Ilias, Lattouf Jean-Baptiste, Drachenberg Darrel, Rendon Ricardo A
Dalhousie University, Halifax, NS.
Can Urol Assoc J. 2012 Dec;6(6):E217-23. doi: 10.5489/cuaj.11012.
The present study documents the natural history and outcomes of high-risk bladder cancer after radical cystectomy (RC) in patients who did not receive neoadjuvant chemotherapy during a contemporary time period.
We analyzed 1180 patients from 1993 to 2008 with >pT3N0 or pT0-4N+ bladder cancer who underwent RC ± standard (sLND) or extended (eLND) lymph node dissection from 8 Canadian centres.
Of the 1180 patients, 55% (n = 643) underwent sLND, 34% (n = 402) underwent ePLND and 11% did not undergo a formal LND. Of the total number of patients, 321 (27%) received adjuvant chemotherapy. The median follow-up was 2.1 years (range: 0.6 to 12.9). Overall 30-day mortality was 3.2%. Clinical and pathological stages T3-4 were present in 6.1% and 86.7% of the patients, respectively; this demonstrates a dramatic understaging. Overall survival (OS) at 2 and 5 years was 60% and 43%, respectively. Patients who received adjuvant chemotherapy had a 2- and 5-year disease-specific survival (DSS) of 72% and 57% versus 64% and 51% for those who did not (log-rank p = 0.0039). The 2- and 5-year OS for high-risk node-negative disease was 67% and 52%, respectively, whereas for node-positive patients, the OS was 52% and 32%, respectively (p < 0.001). The OS, DSS and RFS for patients with pN0 were significantly improved compared to those who did not undergo a LND (log-rank p = 0.0035, 0.0241 and 0.0383, respectively).
This series suggests that bladder cancer outcomes in advanced disease have improved in the modern era. The need for improved staging investigations, use of neoadjuvant chemotherapy and performance of complete LND is emphasized.
本研究记录了当代未接受新辅助化疗的患者行根治性膀胱切除术（RC）后高危膀胱癌的自然病程及预后。
我们分析了1993年至2008年间来自加拿大8个中心的1180例患有>pT3N0或pT0 - 4N +膀胱癌且接受了RC ±标准（sLND）或扩大（eLND）淋巴结清扫术的患者。
在1180例患者中，55%（n = 643）接受了sLND，34%（n = 402）接受了ePLND，11%未接受正式的淋巴结清扫术。在所有患者中，321例（27%）接受了辅助化疗。中位随访时间为2.1年（范围：0.6至12.9年）。30天总体死亡率为3.2%。临床和病理分期为T3 - 4的患者分别占6.1%和86.7%；这表明分期严重不足。2年和5年的总生存率（OS）分别为60%和43%。接受辅助化疗的患者2年和5年疾病特异性生存率（DSS）分别为72%和57%，而未接受辅助化疗的患者为64%和51%（对数秩检验p = 0.0039）。高危淋巴结阴性疾病的2年和5年OS分别为67%和52%，而淋巴结阳性患者的OS分别为52%和32%（p < 0.001）。与未接受淋巴结清扫术的患者相比，pN0患者的OS、DSS和无复发生存率（RFS）显著改善（对数秩检验p分别为0.0035、0.0241和0.0383）。
该系列研究表明，现代晚期膀胱癌的预后有所改善。强调了改进分期检查、使用新辅助化疗以及进行完整淋巴结清扫术的必要性。
