Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey.
Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey.
Urol Oncol. 2025 Jan;43(1):61.e11-61.e18. doi: 10.1016/j.urolonc.2024.09.006. Epub 2024 Sep 30.
To investigate the risk factors affecting cancer-specific survival (CSS) in nonresponsive disease to neoadjuvant chemotherapy (NAC) among patients with muscle-invasive bladder cancer (MIBC) who were treated with NAC and radical cystectomy (RC).
Patients with MIBC who underwent NAC and RC were retrospectively examined. By comparing clinical and pathological stages, patients whose pathological stage was lower than clinical stage were categorized as "NAC-responsive" and the remainder as "NAC-non-responsive." Apart from pathologic staging, variables compared between groups included age, gender, Eastern Cooperative Oncology Group (ECOG) score, clinical stages, NAC type and cycle number, durations between MIBC diagnosis and NAC initiation and RC, presence of hydronephrosis, number of lymph nodes removed, and variant histology of urothelial bladder cancer. CSS analysis was performed by construction of Kaplan-Meier survival curves and multivariable Cox regression was performed to identify the prognosticators in the NAC-non-responsive-group.
Ninety-two patients were included with a mean age was 61.5 ± 8.5 years, of whom 84.8% were men. The NAC regimen used was predominantly gemcitabine-cisplatin (88%) and the median cycle number was 4. Fifty-six (60.9%) patients were NAC-non-responsive. There was a significantly lower proportion of patients receiving ≥4 cycles (46.4% vs. 66.7%) and a higher rate of patients with ECOG score ˃1 (33.9% vs. 11.1%) in the NAC-non-responsive-group compared to the NAC-responsive-group (both P < 0.05). Other variables were similar between groups. In multivariable analysis, only ypN+ was found to be an independent prognosticator for CSS in NAC-non-responsive-group (HR: 2.725, CI95%:1.017-7.303).
Although higher ECOG scores and lower cycle numbers appears to be associated factors in NAC-non-responsive disease, only ypN(+) status was a prognosticator for CSS in this population.
探讨新辅助化疗（NAC）后无反应性疾病患者的影响因素，这些患者患有肌层浸润性膀胱癌（MIBC），并接受了 NAC 和根治性膀胱切除术（RC）治疗。
回顾性检查了接受 NAC 和 RC 的 MIBC 患者。通过比较临床和病理分期，病理分期低于临床分期的患者被归类为“NAC 反应性”，其余患者被归类为“NAC 无反应性”。除了病理分期外，组间比较的变量还包括年龄、性别、东部合作肿瘤组（ECOG）评分、临床分期、NAC 类型和周期数、MIBC 诊断与 NAC 开始和 RC 之间的时间、肾积水的存在、淋巴结切除数以及尿路上皮膀胱癌的变异组织学。通过构建 Kaplan-Meier 生存曲线进行 CSS 分析，并通过多变量 Cox 回归识别 NAC 无反应组中的预后因素。
92 例患者平均年龄为 61.5 ± 8.5 岁，其中 84.8%为男性。使用的 NAC 方案主要为吉西他滨-顺铂（88%），中位周期数为 4 个。56 例（60.9%）患者为 NAC 无反应性。与 NAC 反应性组相比，NAC 无反应组接受≥4 个周期的患者比例明显较低（46.4%比 66.7%），ECOG 评分>1 的患者比例较高（33.9%比 11.1%）（均 P<0.05）。组间其他变量相似。多变量分析显示，仅ypN+是 NAC 无反应组 CSS 的独立预后因素（HR：2.725，95%CI：1.017-7.303）。
虽然较高的 ECOG 评分和较低的周期数似乎是 NAC 无反应性疾病的相关因素，但只有 ypN（+）状态是该人群 CSS 的预后因素。
