新辅助化疗后辅助化疗对根治性膀胱切除术后晚期残留疾病患者生存的影响：系统评价和荟萃分析
Impact of Adjuvant Chemotherapy on Survival of Patients with Advanced Residual Disease at Radical Cystectomy following Neoadjuvant Chemotherapy: Systematic Review and Meta-Analysis.
作者信息
Krajewski Wojciech, Nowak Łukasz, Moschini Marco, Poletajew Sławomir, Chorbińska Joanna, Necchi Andrea, Montorsi Francesco, Briganti Alberto, Sanchez-Salas Rafael, Shariat Shahrokh F, Palou Juan, Babjuk Marek, Teoh Jeremy Yc, Soria Francesco, Pradere Benjamin, Ornaghi Paola Irene, Pawlak Aleksandra, Dembowski Janusz, Zdrojowy Romuald
机构信息
Department of Urology and Oncologic Urology, Wrocław Medical University, 50-556 Wroclaw, Poland.
Klinik für Urologie, Luzerner Kantonsspital, 6004 Lucerne, Switzerland.
出版信息
J Clin Med. 2021 Feb 8;10(4):651. doi: 10.3390/jcm10040651.
BACKGROUND
Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) with pelvic lymph-node dissection is the standard treatment for cT2-4a cN0 cM0 muscle-invasive bladder cancer (MIBC). Despite the significant improvement of primary-tumor downstaging with NAC, up to 50% of patients are eventually found to have advanced residual disease (pT3-T4 and/or histopathologically confirmed nodal metastases (pN+)) at RC. Currently, there is no established standard of care in such cases. The aim of this systematic review and meta-analysis was to assess differences in survival rates between patients with pT3-T4 and/or pN+ MIBC who received NAC and surgery followed by adjuvant chemotherapy (AC), and patients without AC.
MATERIALS AND METHODS
A systematic search was conducted in accordance with the PRISMA statement using the Medline, Embase, and Cochrane Library databases. The last search was performed on 12 November 2020. The primary end point was overall survival (OS) and the secondary end point was disease-specific survival (DSS).
RESULTS
We identified 2124 articles, of which 6 were selected for qualitative and quantitative analyses. Of a total of 3096 participants in the included articles, 2355 (76.1%) were in the surveillance group and 741 (23.9%) received AC. The use of AC was associated with significantly better OS (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.75-0.94; = 0.002) and DSS (HR 0.56, 95% CI 0.32-0.99; = 0.05). Contrary to the main analysis, in the subgroup analysis including only patients with pN+, AC was not significantly associated with better OS compared to the surveillance group (HR 0.89, 95% CI 0.58-1.35; = 0.58).
CONCLUSIONS
The administration of AC in patients with MIBC and pT3-T4 residual disease after NAC might have a positive impact on OS and DSS. However, this may not apply to N+ patients.
背景
以顺铂为基础的新辅助化疗（NAC）后行根治性膀胱切除术（RC）并盆腔淋巴结清扫术是cT2-4a cN0 cM0肌层浸润性膀胱癌（MIBC）的标准治疗方法。尽管NAC使原发肿瘤降期有显著改善，但高达50%的患者最终在RC时被发现有进展期残留疾病（pT3-T4和/或组织病理学证实的淋巴结转移（pN+））。目前，此类病例尚无既定的标准治疗方案。本系统评价和荟萃分析的目的是评估接受NAC和手术继以辅助化疗（AC）的pT3-T4和/或pN+ MIBC患者与未接受AC的患者之间生存率的差异。
材料与方法
按照PRISMA声明，使用Medline、Embase和Cochrane图书馆数据库进行系统检索。最后一次检索于2020年11月12日进行。主要终点是总生存期（OS），次要终点是疾病特异性生存期（DSS）。
结果
我们识别出2124篇文章，其中6篇被选作定性和定量分析。纳入文章的总共3096名参与者中，2355名（76.1%）在监测组，741名（23.9%）接受AC。使用AC与显著更好的OS（风险比（HR）0.84，95%置信区间（CI）0.75-0.94；P = 0.002）和DSS（HR 0.56，95% CI 0.32-0.99；P = 0.05）相关。与主要分析相反，在仅包括pN+患者的亚组分析中，与监测组相比，AC与更好的OS无显著相关性（HR 0.89，95% CI 0.58-1.35；P = 0.58）。
结论
NAC后有pT3-T4残留疾病的MIBC患者给予AC可能对OS和DSS有积极影响。然而，这可能不适用于N+患者。
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