Jayanth E Selvin Theodore, Jat Subhash L, Samuel Benedict P, Singh Ashish, John Nirmal Thampi, Joel Anjana, Mukha Rajiv Paul, Rebecca Grace, Mahasampath Gowri, Berry Chandrasingh Jeyachandra, Devasia Antony, Kekre Nitin, Kumar Santosh
Department of Urology, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
Department of Medical Oncology, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
Indian J Urol. 2025 Jan-Mar;41(1):20-27. doi: 10.4103/iju.iju_214_24. Epub 2025 Jan 1.
Neoadjuvant chemotherapy (NAC) in the management of muscle-invasive bladder carcinoma has not been adopted universally. We studied the oncological outcomes and complications in patients who underwent radical cystectomy (RC) with or without NAC.
A retrospective review of patients who underwent RC with or without NAC from June 2009 to June 2020 was conducted. Oncological outcomes, overall survival (OS) and recurrence-free survival (RFS), complications, and prognostic factors were analyzed.
Of the 314 patients who underwent RC, 83 patients received NAC (Group A), and 231 underwent RC alone (Group B). The median age was 58 years. The median follow-up duration was 22 (3-64) and 24 (3-62) months, respectively. The median OS in Group A was significantly higher than Group B (38 months [confidence interval (CI): 34-42] and 32 [CI: 29-35], respectively, [ = 0.033]). The RFS in Groups A and B was 34 (CI: 30-39) and 31 (CI: 28-34) months, respectively ( = 0.47). Higher pathological T stage (T3/4), node positivity and lymphovascular invasion (LVI) were predictors of poor OS and RFS ( < 0.0001). Clavien grades 3/4 complications were comparable (8% vs. 15%; = 0.19). Glomerular filtration rate (GFR) <60 mL/min/1.73 m was associated with higher postoperative complications in both groups ( = 0.012).
The OS with NAC was superior to upfront RC. RFS was, however, comparable. NAC was safe and well-tolerated. Pathologically, higher T stage, node positivity, and LVI were associated with poorer OS and RFS. Low GFR negatively influenced postoperative complications.
新辅助化疗（NAC）在肌肉浸润性膀胱癌的治疗中尚未得到广泛应用。我们研究了接受或未接受NAC的患者在接受根治性膀胱切除术（RC）后的肿瘤学结局和并发症。
对2009年6月至2020年6月期间接受或未接受NAC的RC患者进行回顾性研究。分析肿瘤学结局、总生存期（OS）和无复发生存期（RFS）、并发症及预后因素。
在314例接受RC的患者中，83例接受了NAC（A组），231例仅接受了RC（B组）。中位年龄为58岁。中位随访时间分别为22（3 - 64）个月和24（3 - 62）个月。A组的中位OS显著高于B组（分别为38个月[置信区间（CI）：34 - 42]和32[CI：29 - 35]，P = 0.033）。A组和B组的RFS分别为34（CI：30 - 39）个月和31（CI：28 - 34）个月（P = 0.47）。较高的病理T分期（T3/4）、淋巴结阳性和淋巴管浸润（LVI）是OS和RFS较差的预测因素（P < 0.0001）。Clavien 3/4级并发症相当（8%对15%；P = 0.19）。两组中肾小球滤过率（GFR）<60 mL/min/1.73 m²与较高的术后并发症相关（P = 0.012）。
NAC治疗的OS优于直接行RC。然而，RFS相当。NAC安全且耐受性良好。病理上，较高的T分期、淋巴结阳性和LVI与较差的OS和RFS相关。低GFR对术后并发症有负面影响。
