Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
J Urol. 2021 Nov;206(5):1258-1267. doi: 10.1097/JU.0000000000001943. Epub 2021 Jun 29.
Data from the pre-neoadjuvant chemotherapy (NAC) era suggests patients who progress on bacillus Calmette-Guérin (BCG) to muscle-invasive bladder cancer (P-MIBC) exhibit worse outcomes compared to MIBC (D-MIBC). Herein, we investigate whether P-MIBC is an independent poor risk factor in the setting of contemporary NAC use.
A review of patients who underwent radical cystectomy (RC) for cT2-3 MIBC from 2005 to 2018 was performed. Patients were stratified into high risk (lymphovascular invasion, variant histology, hydronephrosis, cT3b) vs low risk (no risk factors) and P-MIBC (≤pT1 treated with at least induction BCG who progressed to ≥cT2) vs D-MIBC.
Among 801 patients who underwent RC 20.3% had P-MIBC and 79.7% had D-MIBC. In low-risk patients treated without NAC, P-MIBC was associated with pathological upstaging (64.9% vs 42.7%, p=0.004) and worse overall (OS, p=0.006) and cancer-specific survival (CSS, p=0.001) compared to D-MIBC. P-MIBC status conferred uniformly poor survival outcomes to patients who did not receive NAC compared to D-MIBC without NAC (median OS 51.5 months [95% CI 40.0-81.0] vs 85.1 months [95% CI 62.8-96.0], p=0.040; median CSS not reached, p=0.014). However, P-MIBC status did not remain a negative prognostic factor in the setting of NAC (median OS 90.5 months [95% CI 34.0-not estimable] vs 87.8 months [95% CI 68.7-not estimable], p=0.606; median CSS not reached, p=0.448).
P-MIBC confers a poor prognosis when managed with RC alone. Treatment with NAC results in equivalent pathological response and survival outcomes compared to D-MIBC. P-MIBC should be included in risk-stratified approaches to NAC selection.
来自新辅助化疗（NAC）前时代的数据表明，与肌层浸润性膀胱癌（D-MIBC）相比，卡介苗（BCG）进展为肌层浸润性膀胱癌（P-MIBC）的患者预后更差。在此，我们研究了在当代 NAC 应用背景下，P-MIBC 是否是一个独立的不良风险因素。
对 2005 年至 2018 年期间接受根治性膀胱切除术（RC）治疗的 cT2-3 肌层浸润性膀胱癌患者进行了回顾性分析。患者分为高危（淋巴血管侵犯、变异组织学、肾积水、cT3b）和低危（无危险因素）以及 P-MIBC（≤pT1，至少接受 1 次诱导 BCG 治疗，进展为≥cT2）和 D-MIBC。
在 801 例接受 RC 治疗的患者中，20.3%为 P-MIBC，79.7%为 D-MIBC。在未接受 NAC 治疗的低危患者中，与 D-MIBC 相比，P-MIBC 与病理升级（64.9%比 42.7%，p=0.004）以及总体生存（OS，p=0.006）和癌症特异性生存（CSS，p=0.001）更差。与未接受 NAC 治疗的 D-MIBC 相比，未接受 NAC 治疗的 P-MIBC 患者的生存结局始终较差（中位 OS 51.5 个月[95%CI 40.0-81.0]比 85.1 个月[95%CI 62.8-96.0]，p=0.040；中位 CSS 未达到，p=0.014）。然而，在接受 NAC 治疗的患者中，P-MIBC 状态不再是一个负面的预后因素（中位 OS 90.5 个月[95%CI 34.0-未估计]比 87.8 个月[95%CI 68.7-未估计]，p=0.606；中位 CSS 未达到，p=0.448）。
单独接受 RC 治疗时，P-MIBC 预后不良。与 D-MIBC 相比，NAC 治疗可获得相当的病理缓解和生存结局。P-MIBC 应纳入 NAC 选择的风险分层方法中。
