Ploussard Guillaume, Pradere Benjamin, Beauval Jean-Baptiste, Chevreau Christine, Almeras Christophe, Suc Etienne, Gautier Jean-Romain, Laurenty Anne-Pascale, Roumiguié Mathieu, Loison Guillaume, Tollon Christophe, Mourey Loïc, Salin Ambroise, Xylinas Evanguelos, Pouessel Damien
Department of Urology, La Croix du Sud Hospital, 31130 Quint Fonsegrives, France.
Department of Urology, Bretonneau Hospital, 37000 Tours, France.
J Clin Med. 2020 Jun 23;9(6):1962. doi: 10.3390/jcm9061962.
To compare overall survival (OS) outcomes in pN1-3 disease at the time of radical cystectomy (RC) for muscle invasive bladder according to the neoadjuvant chemotherapy (NAC) status.
This multicenter study included 450 consecutive patients undergoing RC for muscle-invasive urothelial bladder cancer with pN1-3 pM0 disease from 2010 to 2019. NAC consisted in platinum-based chemotherapy. The primary endpoint was the comparison between NAC and non-NAC in terms of death from any cause. OS was assessed using the Kaplan-Meier method and multivariate Cox proportional hazards regression was used to estimate adjusted hazard ratios.
Median age was 69 years. Patients receiving NAC were younger ( = 0.051), and more likely had downstaging to non-muscle invasive disease (10.7% versus 4.3%, = 0.042). Median OS was 26.6 months. NAC patients had poorer OS compared with those who did receive NAC (Hazard ratio (HR) 1.6; = 0.019). The persistence of muscle-invasive bladder in RC specimens was also significantly associated with OS (HR 2.40). In the NAC cohort, the two factors independently correlated with OS were the number of positive lymph nodes ( = 0.013) and adjuvant chemotherapy (AC) (HR 0.31; = 0.015).
Persistent nodal disease in RC specimens after NAC was associated with poor prognosis and lower OS rates compared with pN1-3 disease after upfront RC. In this sub-group of NAC patients, AC was independently associated with better OS.
根据新辅助化疗（NAC）状态，比较根治性膀胱切除术（RC）时pN1 - 3期肌肉浸润性膀胱癌患者的总生存期（OS）结局。
这项多中心研究纳入了2010年至2019年间连续450例接受RC治疗的pN1 - 3 pM0期肌肉浸润性尿路上皮膀胱癌患者。NAC采用铂类化疗。主要终点是比较NAC组和非NAC组的任何原因导致的死亡情况。采用Kaplan - Meier方法评估OS，并使用多变量Cox比例风险回归来估计调整后的风险比。
中位年龄为69岁。接受NAC的患者更年轻（P = 0.051），且更有可能降期为非肌肉浸润性疾病（10.7%对4.3%，P = 0.042）。中位OS为26.6个月。与未接受NAC的患者相比，接受NAC的患者OS较差（风险比（HR）1.6；P = 0.019）。RC标本中肌肉浸润性膀胱的持续存在也与OS显著相关（HR 2.40）。在NAC队列中，与OS独立相关的两个因素是阳性淋巴结数量（P = 0.013）和辅助化疗（AC）（HR 0.31；P = 0.015）。
与 upfront RC后的pN1 - 3期疾病相比，NAC后RC标本中持续存在的淋巴结疾病与预后不良和较低的OS率相关。在这个NAC患者亚组中，AC与更好的OS独立相关。
