Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
Department of Urology, The People's Hospital of Liaoning Province, The People's Hospital of China Medical University, Shenyang, Liaoning, China.
Clin Genitourin Cancer. 2024 Dec;22(6):102211. doi: 10.1016/j.clgc.2024.102211. Epub 2024 Aug 23.
Prior research has demonstrated a discrepancy between pathologic and clinical staging in individuals with muscle-invasive bladder cancer (MIBC) following neoadjuvant chemotherapy (NAC). These findings were the major reasons for the under-usage of the bladder preservation strategy. Hence, we aim to explore the reliable markers in identifying pathological complete response (ypCR) status in MIBC patients who achieved clinical complete response (cCR) after NAC.
Between January 2016 and April 2023, 161 consecutive MIBC patients treated with NAC and achieved cCR were enrolled in the study. Patient clinicopathologic information was documented. Multivariate binary logistic regression was used for determining adjusted odds ratios (OR) and 95% confidence intervals (CI). It considered statistically significant when a P < .05.
Of the 161 MIBC patients with cCR after NAC, 64.0% (103/161) achieved ypCR after RC. The independent factors for ypCR status were the origin of MIBC (secondary vs. Primary) with odds ratios (OR) of 0.433 (P = .027), the pathological type (pure vs. mixed) with OR of 3.556 (P = .003), concurrent carcinoma in situ (yes vs. no) with OR of 0.360 (P = .016), and lymphovascular invasion (yes vs. no) with OR of 0.271 (P = .007).
This study demonstrated that primary MIBC, pure UC pathological type, absence of concurrent CIS, and LVI were significant predictors of ypCR in MIBC patients who achieved cCR after NAC and before surgery. These findings may contribute to the decision-making process of bladder preservation strategy in selected patients.
先前的研究表明，在接受新辅助化疗（NAC）后患有肌层浸润性膀胱癌（MIBC）的个体中，病理分期与临床分期之间存在差异。这些发现是膀胱保留策略使用不足的主要原因。因此，我们旨在探讨在接受 NAC 后达到临床完全缓解（cCR）的 MIBC 患者中，识别病理完全缓解（ypCR）状态的可靠标志物。
2016 年 1 月至 2023 年 4 月，连续纳入 161 例接受 NAC 治疗且达到 cCR 的 MIBC 患者进行研究。记录患者的临床病理信息。采用多变量二项逻辑回归确定调整后的优势比（OR）和 95%置信区间（CI）。当 P <.05 时，认为差异具有统计学意义。
在 161 例接受 NAC 后达到 cCR 的 MIBC 患者中，有 64.0%（103/161）在接受 RC 后达到 ypCR。ypCR 状态的独立因素包括 MIBC 的起源（继发 vs. 原发性），OR 为 0.433（P =.027），病理类型（单纯型 vs. 混合型），OR 为 3.556（P =.003），同时存在原位癌（是 vs. 否），OR 为 0.360（P =.016），以及存在脉管浸润（是 vs. 否），OR 为 0.271（P =.007）。
本研究表明，在接受 NAC 后达到 cCR 且在手术前的 MIBC 患者中，原发性 MIBC、单纯 UC 病理类型、无同时存在 CIS 以及 LVI 是 ypCR 的显著预测因素。这些发现可能有助于为选定患者的膀胱保留策略决策提供依据。
