Chung Rainjade, Moran George W, Wang Connie, McKiernan James M, Anderson Christopher B
Department of Urology, Columbia University Medical Center, New York, NY.
Department of Urology, Columbia University Medical Center, New York, NY.
Urol Oncol. 2022 Dec;40(12):538.e1-538.e5. doi: 10.1016/j.urolonc.2022.09.003. Epub 2022 Oct 8.
Partial cystectomy (PC) is a bladder sparing option to treat bladder cancer in a carefully selected group of patients. We sought to analyze outcomes of partial cystectomy (PC) in a contemporary cohort of patients at a single institution.
Records were reviewed for 43 patients with a primary urothelial carcinoma (UC) who had a partial cystectomy with curative intent at Columbia University Medical Center from 2004 to 2019. Endpoints of interest were noninvasive recurrence (defined as any recurrent nonmuscle invasive disease), advanced recurrence (defined as a muscle invasive recurrence or metastasis), and death. We used unadjusted Cox proportional hazards regressions and log rank tests to estimate the association between clinical characteristics and endpoints of interest.
Among 43 patients with bladder cancer treated with partial cystectomy, median patient age was 73 years (interquartile range 67-77.5) and 86% were male. Twenty-three percent of patients received preoperative neoadjuvant chemotherapy (NAC) and 49% of patients were given perioperative intravesical chemotherapy at the time of PC. Pathologic stage was <T2 for 23 (53%) patients and ≥T2 for 20 (47%) patients. Pathology showed 14% of patients had lymph node involvement, and 9% had positive surgical margins. Mean follow-up was 51 months (range 1-176). Five-year overall survival was 78%. Of 43 patients, 23 patients (53%) had no recurrence, 9 patients (21%) experienced noninvasive intravesical recurrence, and 11 patients (26%) experienced advanced recurrences. Two patients (5%) required salvage radical cystectomy and 8 patients (19%) died of bladder cancer. On univariate analysis, lymphovascular invasion (hazard ratio [HR] 4.4, confidence interval [CI] 1.3-14.3), pathological stage (HR 5.9, CI 1.3-27.4), and NAC (HR 6.5, CI 1.9-22.7) were associated with advanced recurrence. Noninvasive recurrence was associated with not receiving perioperative intravesical chemotherapy (HR 0.7, CI 0.1-6.0).
In well-selected patients, partial cystectomy offers adequate local control of bladder cancer. The risk of systemic progression is similar to reported case series of RC.
部分膀胱切除术（PC）是一种为精心挑选的一组患者保留膀胱的膀胱癌治疗选择。我们试图分析在一家单一机构的当代患者队列中部分膀胱切除术（PC）的结果。
回顾了2004年至2019年在哥伦比亚大学医学中心接受根治性部分膀胱切除术的43例原发性尿路上皮癌（UC）患者的记录。感兴趣的终点是非侵袭性复发（定义为任何复发性非肌层浸润性疾病）、进展期复发（定义为肌层浸润性复发或转移）和死亡。我们使用未调整的Cox比例风险回归和对数秩检验来估计临床特征与感兴趣终点之间的关联。
在43例接受部分膀胱切除术治疗的膀胱癌患者中，患者中位年龄为73岁（四分位间距67 - 77.5），86%为男性。23%的患者接受了术前新辅助化疗（NAC），49%的患者在部分膀胱切除术时接受了围手术期膀胱内化疗。23例（53%）患者的病理分期<T2，20例（47%）患者的病理分期≥T2。病理显示14%的患者有淋巴结受累，9%的患者手术切缘阳性。平均随访时间为51个月（范围1 - 176个月）。5年总生存率为78%。43例患者中，23例（53%）无复发，9例（21%）经历非侵袭性膀胱内复发，11例（26%）经历进展期复发。2例（5%）患者需要挽救性根治性膀胱切除术，8例（19%）患者死于膀胱癌。单因素分析显示，淋巴管浸润（风险比[HR] 4.4，置信区间[CI] 1.3 - 14.3）、病理分期（HR 5.9，CI 1.3 - 27.4）和新辅助化疗（HR 6.5，CI 1.9 - 22.7）与进展期复发相关。非侵袭性复发与未接受围手术期膀胱内化疗相关（HR 0.7，CI 0.1 - 6.0）。
在精心挑选的患者中，部分膀胱切除术能对膀胱癌提供充分的局部控制。全身进展的风险与报道的根治性膀胱切除术病例系列相似。
