Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA.
Int J Clin Oncol. 2019 Jun;24(6):706-711. doi: 10.1007/s10147-019-01409-x. Epub 2019 Feb 1.
Squamous cell carcinoma (SCC) of the bladder is a rare, aggressive malignancy. Unlike urothelial cell carcinoma, SCC is resistant to chemotherapy and guidelines recommend radical cystectomy (RC) without neoadjuvant chemotherapy (NAC). We aimed to evaluate the current management and survival of patients with invasive SCC treated with or without NAC.
671 patients with invasive SCC bladder cancer from 2004 to 2015 in the National Cancer Data Base were identified. Patients were stratified by treatment with RC alone or NAC prior to RC (NAC + RC). Survival analysis was performed with Kaplan-Meier and Cox regression. Secondary outcomes included length of stay and readmission.
Of 671 patients, 92.8% were treated with RC alone and 7.2% with NAC + RC. Cox regression for mortality was performed including age, Charlson score, clinical stage, and NAC. Increased risk of mortality was noted with increasing age (OR 1.01, p = 0.023) and Charlson score of 1-3 (HR 1.58-1.68, p < 0.05). NAC did not confer survival advantage (HR 1.17, p = 0.46). On Kaplan-Meier analysis, the overall survival was equivalent (log-rank p = 0.804). Hospital stay and readmission were similar between RC and NAC + RC groups.
Analysis of a national tumor registry suggests a lack of overall survival benefit for NAC with localized, muscle invasive SCC of the bladder. Further research directed at chemotherapy regimens for SCC is needed to optimize treatment and improve survival outcomes.
膀胱鳞状细胞癌（SCC）是一种罕见且侵袭性的恶性肿瘤。与尿路上皮细胞癌不同，SCC 对化疗具有耐药性，指南建议在不进行新辅助化疗（NAC）的情况下进行根治性膀胱切除术（RC）。我们旨在评估接受或不接受 NAC 的局部浸润性 SCC 患者的当前治疗方法和生存情况。
从 2004 年至 2015 年，在国家癌症数据库中确定了 671 例患有浸润性 SCC 膀胱癌的患者。患者按单独接受 RC 治疗或在接受 RC 前接受 NAC（NAC+RC）治疗进行分层。采用 Kaplan-Meier 和 Cox 回归进行生存分析。次要结局包括住院时间和再入院率。
在 671 例患者中，92.8%接受了单独 RC 治疗，7.2%接受了 NAC+RC 治疗。对死亡率进行 Cox 回归分析，包括年龄、Charlson 评分、临床分期和 NAC。年龄增加（OR 1.01，p=0.023）和Charlson 评分 1-3（HR 1.58-1.68，p<0.05）与死亡率增加相关。NAC 并未带来生存优势（HR 1.17，p=0.46）。在 Kaplan-Meier 分析中，总生存率相当（对数秩检验 p=0.804）。RC 组和 NAC+RC 组的住院时间和再入院率相似。
对国家肿瘤登记处的分析表明，对于局部浸润性 SCC 膀胱癌，NAC 并没有带来整体生存获益。需要进一步研究 SCC 的化疗方案，以优化治疗并改善生存结局。
