Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Department of Urology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
Jpn J Clin Oncol. 2022 Apr 6;52(4):388-396. doi: 10.1093/jjco/hyab210.
Although the administration of neoadjuvant chemotherapy has been associated with improved prognosis in patients with muscle-invasive bladder cancer, the therapeutic effects of adjuvant chemotherapy remain unknown in real-world settings. Therefore, we herein evaluated the clinical outcomes of adjuvant chemotherapy in pT3/4 muscle-invasive bladder cancer patients.
Among 587 bladder cancer patients who underwent radical cystectomy, 200 with a pathological T3 or higher muscle-invasive bladder cancer were included in the present analysis. Recurrence-free survival and cancer-specific survival were assessed by multivariate Cox regression analysis.
Median age was 73 years, and the median follow-up duration was 17 months. The 5-year cancer-specific survival rate was 53.6% in 66 patients treated with adjuvant chemotherapy, which was significantly higher than that in those without adjuvant chemotherapy (34.0%, P = 0.025). The absence of adjuvant chemotherapy (hazard ratio = 2.114, P = 0.004) and lymphovascular invasion (hazard ratio = 2.203, P = 0.011) was identified as independent prognostic indicators for cancer-specific death. In patients treated without neoadjuvant chemotherapy (n = 143), the absence of adjuvant chemotherapy (hazard ratio:1.887, P = 0.030) remained an independent indicator for cancer-specific death. For those treated with adjuvant chemotherapy without neoadjuvant chemotherapy, three or more adjuvant chemotherapy cycles were independently associated with favourable outcome (hazard ratio = 0.240, P = 0.009). In contrast, for neoadjuvant chemotherapy-treated patients (N = 57), adjuvant chemotherapy was not independently associated with disease recurrence or cancer-specific death.
Adjuvant chemotherapy was associated with improvements in the prognosis of patients, even in those with pT3 or higher muscle-invasive bladder cancer. Although three or more cycles of adjuvant chemotherapy were effective for muscle-invasive bladder cancer patients treated without neoadjuvant chemotherapy, no therapeutic advantages were observed with additional adjuvant chemotherapy in patients treated with neoadjuvant chemotherapy.
新辅助化疗的应用与肌层浸润性膀胱癌患者的预后改善相关，但在真实环境下，辅助化疗的疗效仍不清楚。因此，我们在此评估了辅助化疗在 pT3/4 肌层浸润性膀胱癌患者中的临床疗效。
在 587 例接受根治性膀胱切除术的膀胱癌患者中，纳入了 200 例病理 T3 或更高的肌层浸润性膀胱癌患者进行本分析。采用多变量 Cox 回归分析评估无复发生存和癌症特异性生存。
中位年龄为 73 岁，中位随访时间为 17 个月。66 例接受辅助化疗的患者 5 年癌症特异性生存率为 53.6%，明显高于未接受辅助化疗的患者（34.0%，P=0.025）。未接受辅助化疗（风险比=2.114，P=0.004）和脉管侵犯（风险比=2.203，P=0.011）是癌症特异性死亡的独立预后因素。在未接受新辅助化疗的患者（n=143）中，未接受辅助化疗（风险比：1.887，P=0.030）仍然是癌症特异性死亡的独立预后因素。对于接受辅助化疗但未接受新辅助化疗的患者，接受 3 个或更多辅助化疗周期与较好的结局相关（风险比=0.240，P=0.009）。相比之下，对于接受新辅助化疗的患者（N=57），辅助化疗与疾病复发或癌症特异性死亡无关。
辅助化疗与患者预后改善相关，即使在 pT3 或更高的肌层浸润性膀胱癌患者中也是如此。尽管对于未接受新辅助化疗的肌层浸润性膀胱癌患者，接受 3 个或更多周期的辅助化疗是有效的，但对于接受新辅助化疗的患者，额外的辅助化疗并未带来治疗优势。
