Urology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France.
Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France.
World J Urol. 2023 Nov;41(11):3249-3255. doi: 10.1007/s00345-023-04506-9. Epub 2023 Jul 6.
to assess the respective outcomes of patients with localized muscle-invasive bladder cancer (MIBC) treated by either radical cystectomy (RC) or trimodal treatment (TMT) depending on pathological response to previous neoadjuvant chemotherapy (NAC) assessed on cystectomy specimen or post-NAC transurethral resection (TURB) specimen, respectively.
We retrospectively included all consecutive patients treated in one academic center with cisplatin-based NAC followed by RC or TMT for cT2-3N0M0 MIBC between 2014 and 2021. Primary endpoint was metastasis-free survival (MFS) in both treatment groups and according to pathological response to NAC. Local recurrence-free survival and conservative management failure (metastasis-free bladder-intact survival) for patients treated with TMT were assessed.
104 patients were included, 26 treated with TMT and 78 with RC. The rate of complete pathological response was 47.4% in patients treated with RC (ypT0) and 66.7% in patients treated with TMT (ycT0). Median follow-up was 34.9 months. Four-year MFS was 72% in both treatment groups. Four-year MFS was 85% in both ypT0 RC patients and ycT0 TMT patients. ycT0 stage was associated with low rates of intravesical recurrence and conservative management failure.
Patients with post-NAC ycT0 stage treated with TMT have favorable oncological outcomes similar to those of ypT0 patients treated with RC. Assessment of complete histological response with TURB after NAC may help in selecting the best candidates for bladder preservation with TMT.
评估接受根治性膀胱切除术（RC）或三联治疗（TMT）治疗的局限性肌层浸润性膀胱癌（MIBC）患者的各自结局，这取决于在膀胱切除标本或新辅助化疗（NAC）后经尿道膀胱肿瘤切除术（TURB）标本上评估的对 NAC 的病理反应。
我们回顾性纳入了 2014 年至 2021 年期间在一家学术中心接受顺铂为基础的 NAC 治疗后接受 RC 或 TMT 治疗的 cT2-3N0M0 MIBC 连续患者。主要终点是两种治疗组的无转移生存（MFS）和根据 NAC 的病理反应。评估了接受 TMT 治疗的患者的局部无复发生存和保守治疗失败（无转移膀胱完整生存）。
共纳入 104 例患者，26 例接受 TMT 治疗，78 例接受 RC 治疗。RC 治疗患者的完全病理缓解率为 47.4%（ypT0），TMT 治疗患者为 66.7%（ycT0）。中位随访时间为 34.9 个月。两组患者的 4 年 MFS 均为 72%。ypT0 RC 患者和 ycT0 TMT 患者的 4 年 MFS 均为 85%。ycT0 期与膀胱内复发和保守治疗失败的低发生率相关。
接受 NAC 后 ycT0 期治疗的患者接受 TMT 治疗的肿瘤学结局良好，与接受 RC 治疗的 ypT0 患者相似。在 NAC 后通过 TURB 评估完全组织学反应可能有助于选择最适合接受 TMT 膀胱保留的患者。
