Maisch Phillipp, Lunger Lukas, Düwel Charlotte, Schmid Sebastian C, Horn Thomas, Gschwend Jürgen E, Sauter Andreas, Heck Matthias M
Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany.
Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany.
Urol Oncol. 2021 Jun;39(6):368.e11-368.e17. doi: 10.1016/j.urolonc.2020.11.042. Epub 2021 Jan 8.
Radical cystectomy (Cx) is the standard of care for muscle-invasive bladder cancer (BCa). In locally advanced pT4 BCa the oncologic outcome is inexplicit but Cx may be necessary for palliation.
The aim of this retrospective study was to evaluate the outcomes of Cx performed in patients with locally advanced pT4 BCa and to identify patient subgroups with improved outcome.
Between 2008 and 2017, we identified 76 of 905 patients who underwent Cx for pT4 BCa at a single tertiary referral center. The physical patients' status was estimated according to the American Society of Anesthesiologists (ASA) classification. For the classification of postoperative complication rates, the Clavien-Dindo grading was used. Time-to-event variables with log-rank statistics were calculated with the use of the Kaplan-Meier method.
Median age was 74 years (range 42-90). Preoperatively, the physical status was estimated poor in 40 (52%) patients (ASA-score of ≥3). Overall, 19 (25%) patients had pT4b BCa, 41 (54%) patients were lymph node positive (c/pN+) and 14 (18%) patients had distant metastases (c/pM+). Within 30 and 90 days after surgery, 21% and 30% of the patients, respectively, developed severe complications (Clavien-Dindo grade ≥3). Overall, 30- and 90-day mortality rates were 9% and 11%, respectively. Moreover, 86% and 75% of patients who died within 30 and 90 days after surgery, respectively, had an ASA-score ≥3. At a median postoperative follow-up of 8 months (range 0-85), 53 (70%) patients have died. During the follow-up period, 46% of the patients died due to progressive disease, 16% died of a noncancer-specific cause, and for 8% of the patients, the reason remains unknown. Median overall survival (OS) and cancer-specific survival were 13.0 and 16.0 months, respectively. In subgroup analyses ASA-score ≥3 and hemoglobin <11.7 g/dl was significantly associated with poor OS. No statistically significant differences were detected between subgroups.
Cx performed in patients with locally advanced pT4 BCa is associated with an increased mortality rate within 90 days postoperatively. Our study revealed that the ASA-score is a relevant and easily available tool to rate the patient´s condition and estimate postoperative outcome.
根治性膀胱切除术（Cx）是肌层浸润性膀胱癌（BCa）的标准治疗方法。在局部晚期pT4期BCa中，肿瘤学结局尚不明确，但Cx可能是缓解症状所必需的。
本回顾性研究的目的是评估局部晚期pT4期BCa患者行Cx的结局，并确定预后改善的患者亚组。
2008年至2017年期间，我们在一家单一的三级转诊中心从905例行pT4期BCa根治性膀胱切除术的患者中识别出76例。根据美国麻醉医师协会（ASA）分类评估患者的身体状况。对于术后并发症发生率的分类，采用Clavien-Dindo分级。使用Kaplan-Meier方法计算带有对数秩统计的事件发生时间变量。
中位年龄为74岁（范围42-90岁）。术前，40例（52%）患者身体状况评估较差（ASA评分≥3）。总体而言，19例（25%）患者为pT4b期BCa，41例（54%）患者淋巴结阳性（c/pN+），14例（18%）患者有远处转移（c/pM+）。术后30天和90天内，分别有21%和30%的患者发生严重并发症（Clavien-Dindo分级≥3）。总体而言，30天和90天死亡率分别为9%和11%。此外，术后30天和90天内死亡的患者中，分别有86%和75%的患者ASA评分≥3。术后中位随访8个月（范围0-85个月），53例（70%）患者死亡。在随访期间，46%的患者因疾病进展死亡，16%死于非癌症特异性原因，8%患者的死亡原因不明。中位总生存期（OS）和癌症特异性生存期分别为13.0个月和16.0个月。在亚组分析中，ASA评分≥3和血红蛋白<11.7 g/dl与较差的OS显著相关。各亚组之间未检测到统计学显著差异。
局部晚期pT4期BCa患者行Cx与术后90天内死亡率增加相关。我们的研究表明，ASA评分是评估患者病情和估计术后结局的一种相关且易于获得的工具。
