Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA; Harvard Radiation Oncology Program, Boston, MA, USA.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
Eur Urol. 2017 Jun;71(6):952-960. doi: 10.1016/j.eururo.2016.12.020. Epub 2017 Jan 9.
Tri-modality therapy (TMT) is a recognized treatment strategy for selected patients with muscle-invasive bladder cancer (MIBC).
Report long-term outcomes of patients with MIBC treated by TMT.
DESIGN, SETTING, AND PARTICIPANTS: Four hundred and seventy-five patients with cT2-T4a MIBC were enrolled on protocols or treated as per protocol at the Massachusetts General Hospital between 1986 and 2013.
Patients underwent transurethral resection of bladder tumor followed by concurrent radiation and chemotherapy. Patients with less than a complete response (CR) to chemoradiation or with an invasive recurrence were recommended to undergo salvage radical cystectomy.
Disease-specific survival (DSS) and overall survival (OS) were calculated using the Kaplan-Meier method.
Median follow-up for surviving patients was 7.21 yr. Five- and 10-yr DSS rates were 66% and 59%, respectively. Five- and 10-yr OS rates were 57% and 39%, respectively. The risk of salvage cystectomy at 5 yr was 29%. In multivariate analyses, T2 disease (OS hazard ratio [HR]: 0.57, 95% confidence interval [CI]: 0.44-0.75, DSS HR: 0.51, 95% CI: 0.36-0.73), CR to chemoradiation (OS HR: 0.61, 95% CI: 0.46-0.81, DSS HR: 0.49, 95% CI: 0.34-0.71), and presence of tumor-associated carcinoma in situ (OS HR: 1.56, 95% CI: 1.17-2.08, DSS HR: 1.50, 95% CI: 1.03-2.17) were significant predictors for OS and DSS. When evaluating our cohort over treatment eras, rates of CR improved from 66% to 88% and 5-yr DSS improved from 60% to 84% during the eras of 1986-1995 to 2005-2013, while the 5-yr risk of salvage radical cystectomy rate decreased from 42% to 16%.
These data demonstrate high rates of CR and bladder preservation in patients receiving TMT, and confirm DSS rates similar to modern cystectomy series. Contemporary results are particularly encouraging, and therefore TMT should be discussed and offered as a treatment option for selected patients.
Tri-modality therapy is an alternative to radical cystectomy for patients with muscle-invasive bladder cancer, and is associated with comparable long-term survival and high rates of bladder preservation.
三模态治疗（TMT）是一种被认可的治疗选择，适用于特定的肌层浸润性膀胱癌（MIBC）患者。
报告采用 TMT 治疗 MIBC 患者的长期结果。
设计、地点和参与者：1986 年至 2013 年期间，共有 475 名 cT2-T4a MIBC 患者在马萨诸塞州综合医院的协议或按协议接受治疗。
患者接受经尿道膀胱肿瘤切除术，随后进行同期放化疗。对于未完全缓解（CR）的患者或有侵袭性复发的患者，建议进行挽救性根治性膀胱切除术。
采用 Kaplan-Meier 法计算疾病特异性生存率（DSS）和总生存率（OS）。
存活患者的中位随访时间为 7.21 年。5 年和 10 年 DSS 率分别为 66%和 59%。5 年和 10 年 OS 率分别为 57%和 39%。5 年时挽救性膀胱切除术的风险为 29%。在多变量分析中，T2 疾病（OS 风险比 [HR]：0.57，95%置信区间 [CI]：0.44-0.75，DSS HR：0.51，95% CI：0.36-0.73）、对放化疗的 CR（OS HR：0.61，95% CI：0.46-0.81，DSS HR：0.49，95% CI：0.34-0.71）和肿瘤相关原位癌的存在（OS HR：1.56，95% CI：1.17-2.08，DSS HR：1.50，95% CI：1.03-2.17）是 OS 和 DSS 的显著预测因素。当按治疗时代评估我们的队列时，CR 率从 66%提高到 88%，5 年 DSS 从 60%提高到 84%，而 5 年挽救性根治性膀胱切除术的风险从 42%降低到 16%。
这些数据表明，接受 TMT 的患者有很高的 CR 率和保留膀胱的机会，并证实 DSS 率与现代膀胱切除术系列相似。目前的结果尤其令人鼓舞，因此应将 TMT 作为一种治疗选择进行讨论并提供给选定的患者。
三模态治疗是肌层浸润性膀胱癌患者除根治性膀胱切除术之外的另一种选择，与长期生存和高保留膀胱率相关。
