Rodler Severin, Buchner Alexander, Eismann Lennert, Schulz Gerald Bastian, Marcon Julian, Ledderose Stephan, Schlenker Boris, Stief Christian G, Karl Alexander, Jokisch Jan-Friedrich
Department of Urology, Klinikum der Universität München, Munich, Germany.
Department of Pathology, Klinikum der Universität München, Munich, Germany.
Res Rep Urol. 2022 Aug 1;14:281-290. doi: 10.2147/RRU.S374068. eCollection 2022.
Absence of tumor in the final histopathology after radical cystectomy (RC) is a rare but potentially favorable outcome. Therefore, we aimed to analyze outcomes and prognostic factors of patients with urothelial carcinoma (UC) undergoing RC and T0 in the final histology without neoadjuvant chemotherapy at a high-volume academic center.
We retrospectively analyzed patients undergoing RC for pure UC between 2004 and 2020. Cancer-specific survival (CSS) and overall survival (OS) were calculated using Kaplan-Meier analysis and group comparison by Log rank test. Potential prognostic factors were analyzed using univariate Cox regression models.
A total of 1051 patients with UC underwent RC. 72 patients (6.7%) showed pT0 in the final histology. Across all T-stages, 5-year CSS was significantly different with 88% for pT0, 80% for pTa/pTis, 78% for pT1, 76% for pT2, 51% for pT3 and 27% for pT4 in our cohort (p=0.001). Neither instillation therapy (HR 0.31, 95% CI 0.07-1.43), number of TURB prior RC (HR 1.47, 95% CI 0.25-6.18), use of photodynamic diagnostics (PDD) (HR 0.64, 95% CI 0.14-3.02), performing a second resection (HR 0.87, 95% CI 0.27-2.86), muscle-invasive disease prior RC at any TURB (HR 0.7, 95% CI 0.2-2.39) or muscle-invasive disease in the TURB prior RC (HR 1.0, 0.31-3.29) were associated with CSS in univariate analysis.
pT0 reveals a survival benefit in patients undergoing RC for UC and therefore presents a distinctive tumor entity. As clinical and cystoscopic characteristics do not improve patient stratification, further research is warranted to define risk groups in this specific tumor entity.
根治性膀胱切除术（RC）后最终组织病理学检查未发现肿瘤是一种罕见但可能良好的结果。因此，我们旨在分析在一家大型学术中心接受RC且最终组织学为T0且未接受新辅助化疗的尿路上皮癌（UC）患者的结局和预后因素。
我们回顾性分析了2004年至2020年间因单纯UC接受RC的患者。采用Kaplan-Meier分析计算癌症特异性生存率（CSS）和总生存率（OS），并通过对数秩检验进行组间比较。使用单因素Cox回归模型分析潜在的预后因素。
共有1051例UC患者接受了RC。72例患者（6.7%）最终组织学显示为pT0。在所有T分期中，5年CSS有显著差异，我们队列中pT0为88%，pTa/pTis为80%，pT1为78%，pT2为76%，pT3为51%，pT4为27%（p = 0.001）。在单因素分析中，灌注治疗（HR 0.31，95%CI 0.07 - 1.43）、RC前TURB次数（HR 1.47，95%CI 0.25 - 6.18）、光动力诊断（PDD）的使用（HR 0.64，95%CI 0.14 - 3.02）、进行二次切除（HR 0.87，95%CI 0.27 - 2.86）、任何一次TURB时RC前的肌层浸润性疾病（HR 0.7，95%CI 0.2 - 2.39）或RC前TURB中的肌层浸润性疾病（HR 1.0，0.31 - 3.29）均与CSS无关。
pT0在接受RC治疗的UC患者中显示出生存获益，因此代表一种独特的肿瘤实体。由于临床和膀胱镜特征不能改善患者分层，有必要进一步研究以明确这一特定肿瘤实体中的风险组。
