膀胱原位癌并存对膀胱尿路上皮癌新辅助化疗的影响：病理结果较差，但对生存率无影响。
The effect of concomitant carcinoma in situ on neoadjuvant chemotherapy for urothelial cell carcinoma of the bladder: inferior pathological outcomes but no effect on survival.
作者信息
Parker William P, Ho Phillip L, Melquist Jonathan J, Scott Katie, Holzbeierlein Jeffrey M, Lopez-Corona Ernesto, Kamat Ashish M, Lee Eugene K
机构信息
University of Kansas Medical Center, Kansas City, Kansas.
M.D. Anderson Cancer Center, Houston, Texas.
出版信息
J Urol. 2015 May;193(5):1494-9. doi: 10.1016/j.juro.2014.11.003. Epub 2014 Nov 11.
PURPOSE
It is generally believed that carcinoma in situ is refractory to chemotherapy but specific data are lacking to validate this. We evaluated the effect of concomitant clinical carcinoma in situ on cancer specific outcomes after neoadjuvant chemotherapy for muscle invasive bladder cancer.
MATERIALS AND METHODS
We performed an institutional review board approved, multi-institutional, retrospective review of the records of patients treated with neoadjuvant chemotherapy followed by radical cystectomy for muscle invasive bladder cancer from 2008 to 2012. Pretreatment clinical variables were collected and patients were stratified by the presence of clinical carcinoma in situ on precystectomy transurethral bladder tumor resection specimens. Pathological outcomes, including the complete response rate (pT0N0Mx) after neoadjuvant chemotherapy, were compared between the 2 groups. Recurrence-free, cancer specific and overall survival was analyzed.
RESULTS
Of 189 patients who met study criteria 56 (29.6%) had concomitant carcinoma in situ. The condition was associated with a significant decrease in the pathological complete response rate (10.7% vs 26.3%, p = 0.02). This difference was significant on univariate and multivariable analysis (OR 0.34, 95% CI 0.13-0.85, p = 0.02 and OR 0.31, 95% CI 0.12-0.81, p = 0.02, respectively). Despite the decreased complete response rate clinical carcinoma in situ was not associated with a difference in recurrence-free, cancer specific or overall survival. Additionally, when down-staging to pathological carcinoma in situ only disease was considered a complete response, there was no significant change in recurrence-free, cancer specific or overall survival.
CONCLUSIONS
Concomitant carcinoma in situ is associated with a decrease in the complete response rate but this does not appear to impact the survival outcome.
目的
人们普遍认为原位癌对化疗难治，但缺乏具体数据来证实这一点。我们评估了原位临床癌对肌肉浸润性膀胱癌新辅助化疗后癌症特异性结局的影响。
材料与方法
我们对2008年至2012年接受新辅助化疗后行根治性膀胱切除术治疗肌肉浸润性膀胱癌的患者记录进行了机构审查委员会批准的多机构回顾性研究。收集术前临床变量，并根据膀胱切除术前经尿道膀胱肿瘤切除标本中是否存在原位临床癌对患者进行分层。比较两组的病理结局，包括新辅助化疗后的完全缓解率（pT0N0Mx）。分析无复发生存率、癌症特异性生存率和总生存率。
结果
在189例符合研究标准的患者中，56例（29.6%）伴有原位癌。该情况与病理完全缓解率显著降低相关（10.7%对26.3%，p = 0.02）。单因素和多因素分析显示该差异具有统计学意义（OR分别为0.34，95%CI 0.13 - 0.85，p = 0.02和OR 0.31，95%CI 0.12 - 0.81，p = 0.02）。尽管完全缓解率降低，但原位临床癌与无复发生存率、癌症特异性生存率或总生存率的差异无关。此外，当仅将降期至病理原位癌视为完全缓解时，无复发生存率、癌症特异性生存率或总生存率无显著变化。
结论
原位癌与完全缓解率降低相关，但这似乎不影响生存结局。
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