Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI; Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI.
Lifespan Oncology Clinical Research, The Miriam Hospital, Providence, RI.
Urol Oncol. 2020 Mar;38(3):76.e19-76.e28. doi: 10.1016/j.urolonc.2019.09.003. Epub 2019 Oct 5.
Although node-positive (cN+) bladder cancer is considered Stage IV disease, a subset of patients is treated with chemotherapy and consolidative radical cystectomy (RC). We examined the clinical outcomes of such patients and developed a risk prediction model to facilitate risk-stratification and management.
We identified adult patients with cTany cN1-3 M0 urothelial carcinoma of the bladder treated with chemotherapy followed by RC from 2006 to 2013 in the NCDB. The associations of clinicopathologic features with overall survival (OS) were evaluated using Cox regression, and a simplified risk score was developed.
A total of 491 patients received chemotherapy followed by RC. Median number of lymph nodes removed was 16 (interquartile range 9-25). At RC, 10% of patients were ypT0, and 35% were ypN0. Over a median follow-up of 18.7 months, 160 patients died of any cause. 1-, 5-, and 8-year OS were 69%, 34%, and 29%, respectively. On multivariable analysis, pT stage (hazard ratio [HR] 2.18; P = 0.003 for pT3, HR 2.65; P < 0.001 for pT4 vs. <pT2) and pN stage (HR 1.77; P = 0.02 for pN1; HR 2.58; P < 0.001 for pN2; HR 5.09; P < 0.001 for pN3 vs. pN0) were independently associated with worse OS. A risk score was developed based on pT and pN stages, with 5-year OS of 59%, 24%, and 10% for risk score groups of 0-1, 2, and ≥3 points.
Survival for patients with cN+ bladder cancer treated with chemotherapy and RC is highly variable, ranging from 10% to 59% at 5 years. A risk score can facilitate postoperative risk-stratification and selection of patients for adjuvant therapy.
虽然淋巴结阳性（cN+）膀胱癌被认为是 IV 期疾病，但仍有一部分患者接受化疗和根治性膀胱切除术（RC）治疗。我们检查了此类患者的临床结果，并开发了一种风险预测模型，以促进风险分层和管理。
我们从 2006 年至 2013 年在 NCDB 中确定了接受化疗后行 RC 治疗的 cTany cN1-3 M0 尿路上皮膀胱癌的成年患者。使用 Cox 回归评估临床病理特征与总生存（OS）的相关性，并制定简化风险评分。
共有 491 例患者接受化疗后行 RC。切除的淋巴结中位数为 16 个（四分位距 9-25）。在 RC 时，10%的患者为ypT0，35%的患者为ypN0。中位随访 18.7 个月后，160 例患者死于任何原因。1、5 和 8 年 OS 分别为 69%、34%和 29%。多变量分析显示，pT 分期（危险比[HR]2.18；pT3 时 P=0.003，HR2.65；pT4 时 P<0.001 与<pT2）和 pN 分期（HR1.77；pN1 时 P=0.02，HR2.58；pN2 时 P<0.001，HR5.09；pN3 时 P<0.001 与 pN0）与 OS 较差独立相关。根据 pT 和 pN 分期制定了风险评分，风险评分组为 0-1、2 和≥3 分的 5 年 OS 分别为 59%、24%和 10%。
接受化疗和 RC 治疗的 cN+膀胱癌患者的生存情况差异很大，5 年生存率为 10%至 59%。风险评分可促进术后风险分层和辅助治疗患者的选择。
