Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas.
J Urol. 2021 Sep;206(3):577-585. doi: 10.1097/JU.0000000000001784. Epub 2021 Apr 19.
According to the American Urological Association/American Society of Clinical Oncology/American Society for Radiation Oncology/Society of Urologic Oncology Guideline on treatment of nonmetastatic muscle invasive bladder cancer (MIBC), females requiring radical cystectomy (RC) should undergo concomitant anterior pelvic exenteration despite low rates of malignant involvement of gynecologic organs. We present the clinicopathological characteristics of patients with MIBC treated with neoadjuvant chemotherapy (NAC) and evaluate the impact of NAC on gynecologic organ involvement.
An institutional review board approved review of patients with cT2-T3 MIBC treated with RC at our institution between 2005 and 2018 was performed. Patients were stratified by receipt of NAC.
A total of 186 females with cT2-T3 MIBC underwent RC during the study period, of whom 67.7% received NAC prior to RC. Patients who received NAC were more likely to have cT3 disease, preoperative hydronephrosis, and variant histology on transurethral resection (p <0.001, p=0.004, p=0.029, respectively). Rates of recurrence or metastasis were similar between groups (27.0% vs 26.7%, p=0.964). No patients had isolated genitourinary organ recurrence (median followup 32.1 months). Nine patients (5.7%) had gynecologic organ involvement (6 NAC vs 3 no NAC, p=0.978). Among those who underwent hysterectomy, 2 patients (3.1%) who received NAC had uterine involvement compared to none in the no NAC cohort (p=0.551). Rates of vaginal involvement were similar between the groups (4 NAC vs 3 no NAC, p=0.402). Additionally, 1 patient who received NAC had incidentally diagnosed localized endometrial cancer. No women had fallopian tube or ovarian involvement.
Even among high risk patients with MIBC, gynecologic organ involvement of MIBC is rare, and organ preservation, especially of the ovaries, is likely safe.
根据美国泌尿协会/美国临床肿瘤学会/美国放射肿瘤学会/泌尿肿瘤学会关于非转移性肌层浸润性膀胱癌（MIBC）治疗的指南，尽管妇科器官恶性受累的发生率较低，但需要根治性膀胱切除术（RC）的女性应同时进行前盆腔切除术。我们介绍了接受新辅助化疗（NAC）治疗的 MIBC 患者的临床病理特征，并评估了 NAC 对妇科器官受累的影响。
对 2005 年至 2018 年期间在我院接受 RC 治疗的 cT2-T3 MIBC 患者进行了机构审查委员会批准的回顾性研究。患者按是否接受 NAC 进行分层。
在研究期间，共有 186 例 cT2-T3 MIBC 女性接受了 RC，其中 67.7%在 RC 前接受了 NAC。接受 NAC 的患者更有可能患有 cT3 疾病、术前肾盂积水和经尿道切除术的变异组织学（p<0.001，p=0.004，p=0.029）。两组的复发或转移率相似（27.0% vs 26.7%，p=0.964）。没有患者发生孤立的泌尿生殖器官复发（中位随访 32.1 个月）。9 例（5.7%）患者发生妇科器官受累（6 例 NAC 与 3 例无 NAC，p=0.978）。在接受子宫切除术的患者中，2 例（3.1%）接受 NAC 的患者有子宫受累，而无 NAC 组无患者受累（p=0.551）。两组阴道受累率相似（4 例 NAC 与 3 例无 NAC，p=0.402）。此外，1 例接受 NAC 的患者偶然诊断为局限性子宫内膜癌。没有女性发生输卵管或卵巢受累。
即使在 MIBC 高危患者中，MIBC 的妇科器官受累也很少见，保留器官，特别是卵巢，可能是安全的。
