Browne Cliodhna, Davis Niall F, Nolan William J, MacCraith Eoin D, Lennon Gerald M, Mulvin David W, Galvin David J, Quinlan David M
Department of Urology, St. Vincent's University Hospital, Dublin, Ireland.
Curr Urol. 2017 Aug;10(3):132-135. doi: 10.1159/000447166. Epub 2017 Jul 30.
Neoadjuvant chemotherapy (NAC) confers a significant survival benefit in patients with muscle invasive bladder cancer. Platinum-based chemotherapy increases the risk of thromboembolic events (TEE). We determined the effect of cisplatin-based NAC on the incidence of preoperative TEEs in radical cystectomy patients.
A retrospective matched case-control study was performed on 55 patients undergoing radical cystectomy for muscle invasive bladder cancer. Group 1 (n = 20) included patients that received NAC prior to radical cystectomy and Group 2 (n = 35) included patients that underwent radical cystectomy without NAC. Logistic regression analyses tested potential predictors for TEEs in both groups (age, American Society of Anesthesiologists grade, use of NAC, histological subtype, pathological stage).
In total, 6 patients of 55 developed a TEE. Five patients of 20 (25%) treated with NAC prior to radical cystectomy developed TEEs, while 1 of 35 (2.9%) treated with radical cystectomy alone developed a TEE. On univariate and multivariate regression analysis, NAC prior to radical cystectomy was an independent predictor for TEE prior to radical cystectomy (p = 0.033 and p = 0.043, respectively). The effect of perioperative anticoagulation on operative blood loss and postoperative hemoglobin level was not statistically significant between both groups (p = 0.22 and p = 0.08, respectively).
Neoadjuvant cisplatin-based chemotherapy is a significant predictor for preoperative TEE in patients undergoing radical cystectomy.
新辅助化疗（NAC）可使肌层浸润性膀胱癌患者的生存率显著提高。铂类化疗会增加血栓栓塞事件（TEE）的风险。我们确定了基于顺铂的NAC对根治性膀胱切除术患者术前TEE发生率的影响。
对55例因肌层浸润性膀胱癌接受根治性膀胱切除术的患者进行了一项回顾性配对病例对照研究。第1组（n = 20）包括在根治性膀胱切除术前行NAC的患者，第2组（n = 35）包括未行NAC而接受根治性膀胱切除术的患者。逻辑回归分析测试了两组中TEE的潜在预测因素（年龄、美国麻醉医师协会分级、NAC的使用、组织学亚型、病理分期）。
55例患者中共有6例发生TEE。20例在根治性膀胱切除术前行NAC治疗的患者中有5例（25%）发生TEE，而35例仅接受根治性膀胱切除术治疗的患者中有1例（2.9%）发生TEE。在单因素和多因素回归分析中，根治性膀胱切除术前行NAC是根治性膀胱切除术前行TEE的独立预测因素（分别为p = 0.033和p = 0.043）。两组围手术期抗凝对术中失血和术后血红蛋白水平的影响无统计学意义（分别为p = 0.22和p = 0.08）。
基于顺铂的新辅助化疗是接受根治性膀胱切除术患者术前TEE的重要预测因素。
