Nuthalapati Mounish, Menon Arun Ramdas, Patil Vivek Dadasaheb, Sukumaran Sheejamol Velickakathu, Yensani Prashanth Reddy, Agrawal Shashank, Haridas Nikhil Krishna, Nair Haridas, Ganesuni Sohini Chandra, Suresh Nivedita, Rajamma Bindu Mangalath, Pooleri Ginil Kumar
Department of Urologic Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Department of Medical Biostatistics, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Indian J Urol. 2025 Jan-Mar;41(1):28-34. doi: 10.4103/iju.iju_217_24. Epub 2025 Jan 1.
Despite level 1 evidence supporting neoadjuvant chemotherapy (NACT) followed by radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC), its adoption is hindered by concerns about toxicity and detrimental impact on post-RC complications. We retrospectively reviewed post-RC complications at a tertiary care hospital, particularly assessing impact of NACT.
Data from the institutional bladder cancer database were retrieved for patients aged ≥18 with MIBC (≥American Joint Committee on Cancer Clinical Stage T2), treated with RC between May 2013 and July 2023. Exclusions were nonurothelial histology, salvage cystectomy, and palliative intent. Data abstracted included patient characteristics, NACT administration, surgery, and outcomes. Patients were divided into two groups based on NACT and compared. Complications were categorized as early (≤30 days) or late (31-90 days) and graded. Statistical analysis set significance at < 0.05.
Of 154 patients who underwent RC, 33 were excluded due to non-MIBC, nonurothelial histology, or salvage cystectomy. The 121 patients analyzed had a mean age of 64 years and a Charlson Comorbidity Index (CCI) of 4.9. Among them, 61 received NACT and 60 did not. There was no significant difference between the NACT+RC and RC-only groups in overall complication rates (85.3% vs. 75.0%, = 0.16) or in major complications (50.8% vs. 58.3%, = 0.41). CCI >5 predicted major complications, while NACT did not.
In our study of MIBC patients managed at a tertiary care institute in India, NACT administration did not increase postoperative complications.
尽管有一级证据支持新辅助化疗（NACT）联合根治性膀胱切除术（RC）治疗肌层浸润性膀胱癌（MIBC），但其应用因对毒性以及对RC术后并发症的不利影响的担忧而受到阻碍。我们回顾性分析了一家三级医疗中心的RC术后并发症情况，特别评估了NACT的影响。
检索机构膀胱癌数据库中2013年5月至2023年7月期间接受RC治疗的年龄≥18岁的MIBC患者（≥美国癌症联合委员会临床分期T2）的数据。排除标准为非尿路上皮组织学、挽救性膀胱切除术和姑息性治疗。提取的数据包括患者特征、NACT治疗情况、手术及结局。根据是否接受NACT将患者分为两组并进行比较。并发症分为早期（≤30天）或晚期（31 - 90天）并分级。统计学分析设定显著性水平为<0.05。
154例行RC的患者中，33例因非MIBC、非尿路上皮组织学或挽救性膀胱切除术被排除。分析的121例患者平均年龄64岁，Charlson合并症指数（CCI）为4.9。其中，61例接受了NACT，60例未接受。NACT + RC组和单纯RC组在总体并发症发生率（85.3%对75.0%，P = 0.16）或主要并发症发生率（50.8%对58.3%，P = 0.41）方面无显著差异。CCI>5可预测主要并发症，而NACT则不能。
在我们对印度一家三级医疗机构管理的MIBC患者的研究中，NACT治疗并未增加术后并发症。
