Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI Milan, Milan, Italy.
Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
World J Urol. 2018 Apr;36(4):639-644. doi: 10.1007/s00345-018-2190-1. Epub 2018 Jan 24.
Growing literature supports good survival expectancies in bladder cancer (BCa) patients affected by clinical node metastases (cN+) treated with multimodal therapy. We evaluated the role of adjuvant chemotherapy in cN+BCa patients treated with radical cystectomy (RC) and pelvic lymph node dissection (PLND) without neoadjuvant chemotherapy (NAC).
We evaluated a total of 192 patients with BCa and cN+. All patients were treated with RC and PLND without NAC between 2001 and 2013. Kaplan-Meier analyses and Cox regression analyses were used to assess the impact of adjuvant chemotherapy (ACT) on recurrence, cancer-specific mortality (CSM) and overall mortality (OM) after surgery.
Overall, 99 patients (51.6%) were found without node metastases at RC, while 18 (9.4%), 58 (30.2%) and 17 (8.9%) patients were found pN1, pN2 and pN3, respectively. With a median follow-up of 48 months, in cN+ patients we recorded 5-year recurrence, CSM and OM of 55, 53 and 51%, respectively. Overall, 36 (18.8%) patients were treated with adjuvant chemotherapy. At univariable analyses, ACT was associated with improved overall survival [Hazard ratio (HR): 0.42, confidence interval (CI) 0.20-0.86, p = 0.02) in pN+ subgroup only. These results were confirmed at multivariable analyses, where ACT was associated with improved CSS (HR: 0.45, CI 0.21-0.89, p = 0.03) and OS (HR: 0.37, CI 0.17-0.81, p = 0.01).
We report good survival outcomes in cN+ patients treated with RC. The use of ACT after surgery increases survival expectancies, especially in those patients with pathological node disease. Our data need to be further evaluated in prospective setting.
越来越多的文献支持在接受多模式治疗的临床淋巴结转移（cN+）的膀胱癌（BCa）患者中具有良好的生存预期。我们评估了在未接受新辅助化疗（NAC）的情况下接受根治性膀胱切除术（RC）和盆腔淋巴结清扫术（PLND）的 cN+BCa 患者中辅助化疗（ACT）的作用。
我们共评估了 192 例 BCa 和 cN+患者。所有患者均在 2001 年至 2013 年间接受 RC 和 PLND 治疗，未接受 NAC。使用 Kaplan-Meier 分析和 Cox 回归分析评估 ACT 对手术后复发、癌症特异性死亡率（CSM）和总死亡率（OM）的影响。
总体而言，在 RC 时发现 99 例（51.6%）患者无淋巴结转移，而 18 例（9.4%）、58 例（30.2%）和 17 例（8.9%）患者分别为 pN1、pN2 和 pN3。中位随访 48 个月后，cN+患者的 5 年复发率、CSM 和 OM 分别为 55%、53%和 51%。总体而言，有 36 例（18.8%）患者接受了辅助化疗。单变量分析显示，仅在 pN+亚组中，ACT 与总生存率提高相关[风险比（HR）：0.42，95%置信区间（CI）：0.20-0.86，p=0.02]。多变量分析结果也证实了这一点，ACT 与 CSS（HR：0.45，95%CI：0.21-0.89，p=0.03）和 OS（HR：0.37，95%CI：0.17-0.81，p=0.01）的改善相关。
我们报告了接受 RC 治疗的 cN+患者的良好生存结果。手术后使用 ACT 可提高生存预期，特别是在那些有病理淋巴结疾病的患者中。我们的数据需要在前瞻性研究中进一步评估。
