Nagao Kazuhiro, Hara Takahiko, Nishijima Jun, Shimizu Kosuke, Fujii Nakanori, Kobayashi Keita, Kawai Yoshihisa, Inoue Ryo, Yamamoto Yoshiaki, Matsumoto Hiroaki, Matsuyama Hideyasu
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan.
Urol Int. 2017;99(4):446-452. doi: 10.1159/000477912. Epub 2017 Jun 21.
Open radical cystectomy (ORC) is currently the standard treatment for muscle-invasive bladder cancer (MIBC) without metastasis, while many patients with MIBC are not always appropriate candidates due to multiple comorbidities. To evaluate the bladder-preservation strategy, we compared the results with those obtained by ORC.
We retrospectively analyzed the data of 50 patients with MIBC treated by trimodal chemoradiotherapy with cisplatin (CDDP-radiation [CDDP-R]). Transurethral resection of the bladder tumor (TURBT) was performed before treatment to confirm pathological stage ≥T2. Extensive TURBT was performed after chemoradiotherapy to evaluate the pathological response to treatment. We compared the survival outcomes of our CDDP-R with those of ORC (retrospective cohort, n = 205) by propensity score matching analysis.
The 2- and 5-year progression-free survival, bladder-intact survival, cancer-specific survival, and overall survival (OS) rates after treatment were 70.8 and 63.9%, 64.0 and 49.8%, 86.7 and 71.8%, and 84.3 and 64.8%, respectively. The 2- and 5-year OS rates after CDDP-R were 90.5 and 74.3%, respectively, and those after ORC were 71.8 and 59.9%, respectively, indicating a significant survival advantage conferred by CDDP-R over ORC (p < 0.05, HR 0.45, 95% CI 0.21-0.94).
In selected patients, CDDP-R for MIBC may provide comparative oncological outcomes as ORC.
开放性根治性膀胱切除术（ORC）目前是无转移的肌层浸润性膀胱癌（MIBC）的标准治疗方法，然而，由于多种合并症，许多MIBC患者并不总是合适的候选者。为了评估膀胱保留策略，我们将结果与ORC获得的结果进行了比较。
我们回顾性分析了50例接受顺铂三联放化疗（CDDP-放疗[CDDP-R]）治疗的MIBC患者的数据。治疗前进行经尿道膀胱肿瘤切除术（TURBT）以确认病理分期≥T2。放化疗后进行广泛的TURBT以评估治疗的病理反应。我们通过倾向评分匹配分析比较了我们的CDDP-R与ORC（回顾性队列，n = 205）的生存结果。
治疗后的2年和5年无进展生存率、膀胱完整生存率、癌症特异性生存率和总生存率（OS）分别为70.8%和63.9%、64.0%和49.8%、86.7%和71.8%、84.3%和64.8%。CDDP-R后的2年和5年OS率分别为90.5%和74.3%，ORC后的分别为71.8%和59.9%，表明CDDP-R比ORC具有显著的生存优势（p < 0.05，HR 0.45，95% CI 0.21-0.94）。
在选定的患者中，MIBC的CDDP-R可能提供与ORC相当的肿瘤学结果。
