Nikulainen Ilkka, Salminen Antti P, Högerman Mikael, Seikkula Heikki, Boström Peter J
Department of Urology, University of Turku and Turku University Hospital, 20521 Turku, Finland.
Department of Surgery, Division of Urology, Central Hospital of Jyväskylä, 40620 Jyväskylä, Finland.
Cancers (Basel). 2025 Feb 3;17(3):505. doi: 10.3390/cancers17030505.
To investigate neoadjuvant chemotherapy (NAC) eligibility, utilization, and survival outcomes for muscle-invasive bladder cancer patients undergoing radical cystectomy (RC) in a Finnish population.
Data from the Finnish National Cystectomy Database (2005-2017) was combined with Finnish Cancer Registry survival data. NAC utilization rates were reported, and downstaging rates were calculated based on final pathological staging. Logistic regression analyzed NAC usage and complete response (CR) predictors.
Since 2011, 29% of 1157 patients received NAC. Its usage remained consistent, and the number of eligible patients not receiving NAC decreased during the study period. Among NAC patients, pathology T-category was pT0 (34%), pT1-Ta-Tis (16%), pT2 (23%), pT3 (20%), and pT4 (7%) tumors, with pN0 in 82%. In the RC + NAC group, the 5-year overall survival (OS) rates were 89% for patients with no residual disease (pT0N0), 82% for those with organ-confined residual disease (pT1, Tis, Ta, T2/N0), and 49% for patients with non-organ-confined residual disease (pT3+/N+). The corresponding cancer-specific survival (CSS) rates were 93%, 86%, and 57%, respectively. Patients with organ-confined residual disease after NAC had survival outcomes comparable to those who underwent RC alone. Higher age; odds ratio (OR) 0.93, [95% Confidence Interval (CI): 0.90-0.95] and Charlson Co-morbidity Index-score [OR 0.88 (0.79-0.98)] reduced the likelihood of receiving NAC, while a smaller center size increased the probability [OR 1.82 (1.02-3.28)]. More treatment cycles [OR 0.70, (95% CI: 0.51-0.93)] and a favorable GFR [OR 0.38 (0.16-0.88)] were associated with achieving CR.
We report that NAC is well-utilized across Finland, with CR rates comparable to recent trials. Additionally, our survival rates are reasonable, and even with organ-confined residual disease after NAC, survival outcomes are similar to those who underwent RC alone.
研究芬兰肌肉浸润性膀胱癌患者接受根治性膀胱切除术（RC）时新辅助化疗（NAC）的适用性、使用率及生存结果。
将芬兰国家膀胱切除术数据库（2005 - 2017年）的数据与芬兰癌症登记处的生存数据相结合。报告NAC使用率，并根据最终病理分期计算降期率。采用逻辑回归分析NAC使用情况及完全缓解（CR）的预测因素。
自2011年以来，1157例患者中有29%接受了NAC。其使用率保持稳定，研究期间未接受NAC的符合条件患者数量有所减少。在接受NAC的患者中，病理T分期为pT0（34%）、pT1 - Ta - Tis（16%）、pT2（23%）、pT3（20%）和pT4（7%）的肿瘤，82%为pN0。在RC + NAC组中，无残留疾病（pT0N0）患者的5年总生存率（OS）为89%，有器官局限性残留疾病（pT1、Tis、Ta、T2/N0）的患者为82%，有非器官局限性残留疾病（pT3 + /N +）的患者为49%。相应的癌症特异性生存率（CSS）分别为93%、86%和57%。NAC后有器官局限性残留疾病的患者生存结果与单纯接受RC的患者相当。年龄较大；优势比（OR）0.93，[95%置信区间（CI）：0.90 - 0.95]和Charlson合并症指数评分[OR 0.88（0.79 - 0.98）]会降低接受NAC的可能性，而中心规模较小则会增加这种可能性[OR 1.82（1.02 - 3.28）]。更多的治疗周期[OR 0.70，（95% CI：0.51 - 0.93）]和良好的肾小球滤过率（GFR）[OR 0.38（0.16 - ......
