Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Postbus 90203, 1006 BE Amsterdam, The Netherlands.
Eur J Surg Oncol. 2013 Apr;39(4):365-71. doi: 10.1016/j.ejso.2013.01.003. Epub 2013 Jan 31.
To evaluate the outcome of patients with locally advanced muscle-invasive and/or lymph node positive bladder cancer treated with induction chemotherapy and additional surgery.
All patients who were treated with induction chemotherapy in our institution between 1990 and 2010, were retrospectively evaluated using an institutional database. Induction chemotherapy consisted of methotrexate, vinblastine, doxorubicin and cisplatin (MVAC), or a combination of gemcitabine with either cisplatin or carboplatin (GC).
In total 152 patients were identified, with a mean age of 59 years (range 31-76). One hundred and seven patients (70.4%) received MVAC, 35 patients received GC (23.0%) and 10 patients received GC after initial treatment with MVAC (6.6%). Median follow-up was 68 months (range 4-187 months). Overall 125 patients (82.2%) underwent cystectomy, whereas 12 patients (7.9%) received radiotherapy. Fifteen patients had no local treatment. Median overall survival was 18 months (95%CI 15-23 months). In 37.5% of patients with complete clinical response, residual disease was found at surgery (positive predictive value, PPV 62.5%). Complete pathological response was seen in 26.3% of patients, with a 5 year overall survival (OS) estimate of 54% (39%-74%). For patients with persisting node positive disease after induction chemotherapy and surgery OS was significantly worse (p < 0.0001).
Complete clinical and/or pathological response to induction chemotherapy results in a significant survival benefit. The accuracy of the current clinical response evaluation after induction chemotherapy is limited. Although surgery may be important for staging and prognostic purposes, its role is unclear in node positive disease after induction chemotherapy.
评估接受诱导化疗和辅助手术治疗的局部晚期肌层浸润性和/或淋巴结阳性膀胱癌患者的治疗结果。
通过机构数据库，回顾性评估了 1990 年至 2010 年期间在本机构接受诱导化疗的所有患者。诱导化疗方案包括甲氨蝶呤、长春碱、多柔比星和顺铂（MVAC），或吉西他滨联合顺铂或卡铂（GC）。
共确定了 152 例患者，平均年龄 59 岁（范围 31-76 岁）。107 例患者（70.4%）接受 MVAC 治疗，35 例患者接受 GC 治疗（23.0%），10 例患者在接受初始 MVAC 治疗后接受 GC 治疗（6.6%）。中位随访时间为 68 个月（范围 4-187 个月）。125 例患者（82.2%）接受了膀胱切除术，12 例患者（7.9%）接受了放疗。15 例患者未进行局部治疗。总生存期中位数为 18 个月（95%CI 15-23 个月）。在完全临床缓解的 37.5%患者中，手术时发现残留疾病（阳性预测值，PPV 62.5%）。26.3%的患者出现完全病理缓解，5 年总生存率（OS）估计值为 54%（39%-74%）。对于诱导化疗和手术后淋巴结阳性疾病持续存在的患者，OS 显著更差（p<0.0001）。
完全的临床和/或病理缓解诱导化疗可显著改善生存获益。目前诱导化疗后临床反应评估的准确性有限。尽管手术可能对分期和预后具有重要意义，但在诱导化疗后淋巴结阳性疾病中的作用尚不清楚。
