Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Department of Genitourinary Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
BJU Int. 2018 Jul;122(1):89-98. doi: 10.1111/bju.14211. Epub 2018 Apr 23.
To determine whether the recovery window (RW) between neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) affects 90-day postoperative morbidity and incidence of lymph node metastasis.
We reviewed patients treated with NAC and RC from 1995 to 2013 for ≤cT N M bladder cancer. The association of the RW with 90-day perioperative morbidity and lymph node metastasis was determined. Generalised linear models were used to determine predictors of each endpoint. Patients were stratified into four RWs by 21-day intervals (18-42; 43-63; 64-84; and ≥85 days) from last day of NAC to RC.
We evaluated 306 patients with RW information during the study period. The median (range) RW was 46 (18-199) days. There was no difference in overall morbidity, re-admission, or major complication rates amongst the four RWs. In the multivariable analysis extravesical disease was an independent predictor of overall morbidity (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.16-3.26; P = 0.011). Age (OR 1.05, 95% CI: 1.02-1.09; P = 0.004), and surgical duration ≥7 h (OR 2.87, 95% CI: 1.52-5.42; P = 0.001) were independent predictors of major complications. Only surgical duration ≥7 h was a predictor of re-admission (OR 2.24; 95% CI: 1.26-3.98; P = 0.006). A RW of ≥85 days had the highest incidence of node-positive disease (pN+; 40%). In a separate multivariable model that included clinical predictors for pN+, a RW of ≥85 days was an independent predictor of nodal metastasis (OR 2.92, 95% CI: 1.20-7.09; P = 0.018).
Patients treated with NAC for bladder cancer can undergo RC between 18 and 84 days (2.5-12 weeks) after NAC with no difference in the risk of perioperative morbidity. Delaying surgery beyond 12 weeks was associated with a significant risk of lymph node metastasis.
确定新辅助化疗（NAC）和根治性膀胱切除术（RC）之间的恢复窗口期（RW）是否会影响术后 90 天的发病率和淋巴结转移率。
我们回顾了 1995 年至 2013 年间接受 NAC 和 RC 治疗的≤cT N M 膀胱癌患者的资料。通过广义线性模型确定 RW 与 90 天围手术期发病率和淋巴结转移的关系。将患者按 21 天间隔（18-42、43-63、64-84 和≥85 天）从 NAC 最后一天到 RC 分为四个 RW 组。
我们评估了研究期间有 RW 信息的 306 名患者。中位（范围）RW 为 46（18-199）天。四个 RW 组之间的总体发病率、再入院率或主要并发症发生率无差异。在多变量分析中，膀胱外疾病是总体发病率的独立预测因素（优势比[OR]1.95，95%置信区间[CI]1.16-3.26；P=0.011）。年龄（OR 1.05，95%CI：1.02-1.09；P=0.004）和手术时间≥7 h（OR 2.87，95%CI：1.52-5.42；P=0.001）是主要并发症的独立预测因素。只有手术时间≥7 h 是再入院的预测因素（OR 2.24；95%CI：1.26-3.98；P=0.006）。RW≥85 天的患者淋巴结阳性疾病（pN+）的发生率最高（40%）。在一个包括 pN+临床预测因素的单独多变量模型中，RW≥85 天是淋巴结转移的独立预测因素（OR 2.92，95%CI：1.20-7.09；P=0.018）。
接受 NAC 治疗的膀胱癌患者在 NAC 后 18 至 84 天（2.5-12 周）内可进行 RC，手术期间发病率无差异。手术时间延迟超过 12 周与淋巴结转移的风险显著增加有关。
