Culine Stéphane, Harter Valentin, Krucker Clémentine, Gravis Gwenaelle, Fléchon Aude, Chevreau Christine, Mahammedi Hakim, Laguerre Brigitte, Guillot Aline, Joly Florence, Fontugne Jacqueline, Allory Yves, Pfister Christian
Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Nord, Université de Paris Cité, Avenue Claude Vellefaux, 75010 Paris, France.
North-West Canceropole Data Center, Baclesse Cancer Center, 14000 Caen, France.
Cancers (Basel). 2023 Mar 13;15(6):1742. doi: 10.3390/cancers15061742.
Neoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy and pelvic lymph node dissection is the optimal treatment for patients with muscle-invasive bladder cancer. In recent years, the VESPER trial showed a statistically significant higher progression-free survival with dd-MVAC (dose dense methotrexate, vinblastine, doxorubicin, and cisplatin) compared to GC (gemcitabine and cisplatin). In the present report, we refine the characterization and outcome of patients whose cystectomy specimens were pathologically free of cancer (pathological complete response, pCR). We confirm that these patients portend a better outcome as compared to patients with invasive disease (≥pT1N0) at cystectomy. Nested variant and lymphovascular invasion were identified as adverse predictive factors of pCR. Progression-free survival probability three years after pCR on cystectomy was about 85%, regardless of the NAC regimen. A lower creatinine clearance and the delivery of less than four cycles were associated with a higher risk of relapse. Predicting the efficacy of NAC remains a major challenge. The planned analysis of molecular subtypes in the VESPER trial could help predict which patients may achieve complete response and better outcome.
以顺铂为基础的新辅助化疗（NAC），随后进行根治性膀胱切除术和盆腔淋巴结清扫术，是肌层浸润性膀胱癌患者的最佳治疗方法。近年来，VESPER试验显示，与GC（吉西他滨和顺铂）相比，剂量密集型MVAC（剂量密集型甲氨蝶呤、长春花碱、阿霉素和顺铂）的无进展生存期在统计学上显著更高。在本报告中，我们细化了膀胱切除标本病理上无癌（病理完全缓解，pCR）患者的特征和预后。我们证实，与膀胱切除时患有浸润性疾病（≥pT1N0）的患者相比，这些患者预后更好。巢状变异和淋巴管浸润被确定为pCR的不良预测因素。无论NAC方案如何，膀胱切除术后pCR三年的无进展生存概率约为85%。较低的肌酐清除率和少于四个周期的化疗与较高的复发风险相关。预测NAC的疗效仍然是一项重大挑战。VESPER试验中对分子亚型的计划分析可能有助于预测哪些患者可能实现完全缓解并获得更好的预后。
