经三联膀胱保留疗法治疗的尿路上皮癌组织学变异型患者的临床结局。
Clinical Outcomes of Patients with Histologic Variants of Urothelial Cancer Treated with Trimodality Bladder-sparing Therapy.
机构信息
Department of Urology, Massachusetts General Hospital. Harvard Medical School, Boston, MA, USA.
Department of Radiation Oncology, Massachusetts General Hospital. Harvard Medical School, Boston, MA, USA.
出版信息
Eur Urol. 2017 Jul;72(1):54-60. doi: 10.1016/j.eururo.2016.12.002. Epub 2016 Dec 28.
BACKGROUND
Trimodality bladder-sparing therapy (TMT) is an acceptable treatment for selected patients with muscle-invasive urothelial cancer. Outcomes of TMT in histologic variants remains largely unknown.
OBJECTIVE
To compare outcomes of pure urothelial carcinoma (PUC) to variant urothelial carcinoma (VUC) after TMT.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of patients treated with TMT at a single cancer center from 1993 until 2013.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Kaplan-Meier survival probabilities, and univariate and multivariable Cox regression analysis.
RESULTS AND LIMITATIONS
Of 303 patients treated with TMT, 66 (22%) had VUC. Fifty (76%) had VUC with squamous and/or glandular differentiation and 16 (24%) had other forms. Complete response rate after induction TMT was 83% in PUC and 82% in VUC (p=0.9). The 5-yr and 10-yr disease-specific survival (DSS) was 75% and 67% in PUC versus 64% and 64% in VUC. The 5-yr and 10-yr overall survival (OS) was 61% and 42% in PUC versus 52% and 42% in VUC. On multivariable analysis VUC was not associated with DSS (hazard ratio: 1.3, 95% confidence interval: 0.8-2.2, p=0.3) or OS (hazard ratio: 1.2, 95% confidence interval: 0.8-1.7, p=0.4). Salvage cystectomy rates were similar (log-rank p=0.3). Limitations include retrospective design and restriction to variants of urothelial cancer.
CONCLUSIONS
VUC responded to TMT, and there was no significant difference in complete response, OS, DSS, or salvage cystectomy rates compared with PUC. The presence of VUC should not exclude patients from TMT.
PATIENT SUMMARY
The response of histologic variants of bladder cancer to bladder-sparing chemoradiation is largely unknown. We compared the outcomes of histologic variants of urothelial cancer to pure urothelial cancer in a large series of patients from a single institution. We found that variant histology does not significantly influence outcomes.
背景
三联疗法（TMT）是一种可接受的治疗方法，适用于选定的肌层浸润性尿路上皮癌患者。TMT 治疗组织学变异型的结果在很大程度上尚不清楚。
目的
比较 TMT 后纯尿路上皮癌（PUC）与变异型尿路上皮癌（VUC）的结果。
设计、地点和参与者：对 1993 年至 2013 年在单一癌症中心接受 TMT 治疗的患者进行回顾性研究。
结局测量和统计分析
使用 Kaplan-Meier 生存概率和单变量及多变量 Cox 回归分析。
结果和局限性
在接受 TMT 治疗的 303 例患者中，66 例（22%）患有 VUC。50 例（76%）有鳞状和/或腺分化的 VUC，16 例（24%）有其他形式的 VUC。PUC 和 VUC 的诱导 TMT 后完全缓解率分别为 83%和 82%（p=0.9）。5 年和 10 年疾病特异性生存率（DSS）分别为 PUC 的 75%和 67%，VUC 的 64%和 64%。5 年和 10 年总生存率（OS）分别为 PUC 的 61%和 42%，VUC 的 52%和 42%。多变量分析显示，VUC 与 DSS（风险比：1.3，95%置信区间：0.8-2.2，p=0.3）或 OS（风险比：1.2，95%置信区间：0.8-1.7，p=0.4）无关。挽救性膀胱切除术的比率相似（对数秩检验 p=0.3）。局限性包括回顾性设计和对尿路上皮癌的限制。
结论
VUC 对 TMT 有反应，与 PUC 相比，完全缓解、OS、DSS 或挽救性膀胱切除术的比率没有显著差异。VUC 的存在不应排除患者接受 TMT。
患者总结
膀胱保存放化疗对膀胱癌组织学变异型的反应尚不清楚。我们比较了来自单一机构的大量患者中 VUC 与纯尿路上皮癌的结局。我们发现，组织学变异对结果没有显著影响。
Zotero 插件