Institute of Urology, Capital Medical University, Department of Urology, Capital Medical University Beijing Chao-Yang Hospital, Beijing, 100020, China.
School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.
BMC Urol. 2019 Nov 16;19(1):117. doi: 10.1186/s12894-019-0552-7.
Bladder cancer is a complex disease associated with high morbidity and mortality. Management of bladder cancer before radical cystectomy continues to be controversial. We compared the long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy (IAC) versus no IAC (NIAC) before radical cystectomy (RC) for bladder cancer.
We performed a retrospective review of patients who underwent either one-shot IAC or NIAC before RC between October 2006 and November 2015. A propensity-score matching (1:3) was performed based on key characters. The Kaplan-Meier method was utilized to estimate survival probabilities, and the log-rank test was used to compare survival outcomes between different groups. A multivariable Cox proportional hazard model was used to estimate survival outcomes.
Twenty-six patients were treated using IAC before RC, and 123 NIAC patients also underwent RC. After matching, there was no significant difference between groups in baseline characteristics, perioperative variables, complication outcomes or tumor characteristics. Compared with clinical tumor stages, pathological tumor stages demonstrated a significant decrease (P = 0.002) in the IAC group. There was no significant difference in overall survival (OS, p = 0.354) or cancer-specific survival (CSS, p = 0.439) between the groups. Among all patients, BMI significantly affected OS (p = 0.004), and positive lymph nodes (PLN) significantly affected both OS (p<0.001) and CSS (p = 0.010).
One-shot neoadjuvant IAC before RC shows safety and tolerability and provides a significant advantage in pathological downstaging but not in OS or CSS. Further study of neoadjuvant combination therapeutic strategies with RC is needed.
膀胱癌是一种复杂的疾病，具有较高的发病率和死亡率。根治性膀胱切除术（RC）前的膀胱癌管理仍存在争议。我们比较了单次新辅助动脉内化疗（IAC）与 RC 前不进行 IAC（NIAC）治疗膀胱癌的长期疗效。
我们回顾性分析了 2006 年 10 月至 2015 年 11 月间接受单次 IAC 或 NIAC 治疗的患者。根据关键特征进行倾向评分匹配（1:3）。采用 Kaplan-Meier 法估计生存概率，对数秩检验比较不同组间的生存结果。采用多变量 Cox 比例风险模型估计生存结果。
26 例患者接受 IAC 治疗，123 例 NIAC 患者同时接受 RC。匹配后，两组患者的基线特征、围手术期变量、并发症结局或肿瘤特征均无显著差异。与临床肿瘤分期相比，IAC 组病理肿瘤分期显著下降（P = 0.002）。两组间总生存期（OS，p = 0.354）或癌症特异性生存期（CSS，p = 0.439）无显著差异。在所有患者中，BMI 显著影响 OS（p = 0.004），阳性淋巴结（PLN）显著影响 OS（p<0.001）和 CSS（p = 0.010）。
RC 前单次新辅助 IAC 显示出安全性和耐受性，在病理降期方面具有显著优势，但在 OS 或 CSS 方面没有优势。需要进一步研究 RC 联合新辅助治疗策略。
