Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York.
Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York.
J Urol. 2018 Nov;200(5):1005-1013. doi: 10.1016/j.juro.2018.05.078. Epub 2018 May 19.
We report the outcomes in patients with muscle invasive bladder cancer from 2 institutions who experienced a clinically complete response to neoadjuvant platinum based chemotherapy and elected active surveillance. It was unknown whether conservative treatment could be safely implemented in these patients.
We retrospectively reviewed the records of patients with muscle invasive bladder cancer at our institutions who elected surveillance following a clinically complete response to transurethral resection of bladder tumors and neoadjuvant chemotherapy from 2001 to 2017. A clinically complete response was defined as absent tumor on post-chemotherapy transurethral resection of bladder tumor, negative cytology and normal cross-sectional imaging.
In the 148 patients followed a median of 55 months (range 5 to 145) the 5-year disease specific, overall, cystectomy-free and recurrence-free survival rates were 90%, 86%, 76% and 64%, respectively. Of the patients 71 (48%) experienced recurrence in the bladder, including 16 (11%) with muscle invasive disease and 55 (37%) with noninvasive disease. Salvage radical cystectomy prevented cancer specific death in 9 of 12 patients (75%) who underwent cystectomy after muscle invasive relapse and in 13 of 14 (93%) after noninvasive relapse.
We observed high rates of overall and disease specific survival with bladder preservation in patients who achieved a clinically complete response to neoadjuvant chemotherapy. These outcomes support the safety of active surveillance in carefully selected, closely monitored patients with muscle invasive bladder cancer. Future studies should aim to improve patient selection by identifying biomarkers predicting invasive relapse and developing novel imaging methods of early detection.
我们报告了来自 2 家机构的肌层浸润性膀胱癌患者的结果，这些患者在接受新辅助铂类化疗后出现临床完全缓解，并选择主动监测。尚不清楚是否可以在这些患者中安全实施保守治疗。
我们回顾了 2001 年至 2017 年期间，在我们的机构中，接受经尿道膀胱肿瘤切除术和新辅助化疗后出现临床完全缓解（定义为化疗后经尿道膀胱肿瘤切除术未见肿瘤、细胞学阴性和正常横断面成像）并选择监测的肌层浸润性膀胱癌患者的病历。
在 148 例中位随访时间为 55 个月（范围 5 至 145）的患者中，5 年疾病特异性、总体生存率、无膀胱切除术生存率和无复发生存率分别为 90%、86%、76%和 64%。71 例（48%）患者在膀胱内复发，其中 16 例（11%）为肌层浸润性疾病，55 例（37%）为非浸润性疾病。挽救性根治性膀胱切除术可预防 12 例（75%）肌层浸润性复发后和 14 例（93%）非肌层浸润性复发后癌症特异性死亡。
我们观察到在新辅助化疗后达到临床完全缓解的患者中，保膀胱治疗的总生存率和疾病特异性生存率较高。这些结果支持在经过精心挑选和密切监测的肌层浸润性膀胱癌患者中进行主动监测的安全性。未来的研究应通过确定预测侵袭性复发的生物标志物和开发早期检测的新型影像学方法来改善患者选择。
