接受根治性膀胱切除术的临床淋巴结阳性膀胱癌患者的预后影响

Prognostic Implications of Patients With Clinically Node Positive Bladder Cancer Undergoing Radical Cystectomy.

作者信息

Scilipoti Pietro, Moschini Marco, Zaurito Paolo, Longoni Mattia, De Angelis Mario, Afferi Luca, Lonati Chiara, Tremolada Giovanni, Viti Alessandro, Santangelo Alfonso, Pichler Renate, Necchi Andrea, Montorsi Francesco, Briganti Alberto, Mari Andrea, Krajewski Wojciech, Laukthina Ekaterina, Pradere Benjamin, Giudice Francesco Del, Mertens Laura, Gallioli Andrea, Soria Francesco, Gontero Paolo, Albisinni Simone, Shariat Shahrokh F, Carando Roberto

机构信息

Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.

出版信息

Clin Genitourin Cancer. 2025 Aug;23(4):102377. doi: 10.1016/j.clgc.2025.102377. Epub 2025 May 17.

DOI:10.1016/j.clgc.2025.102377

PMID:40514269

Abstract

INTRODUCTION AND OBJECTIVES

Patients with clinically node-positive (cN+) bladder cancer (BCa) form a biologically and prognostically diverse group. As systemic therapy reshapes management in this setting, this study examines oncological outcomes after radical cystectomy (RC) with or without perioperative systemic therapy.

MATERIALS AND METHODS

We utilized a multicenter, retrospectively collected database of 1067 patients diagnosed with cTanyN+M0 BCa who underwent RC with lymphadenectomy with or without perioperative systemic treatment. Patients with cN1-2 disease and treated from 2006 and 2023 were included. Three-months landmark Kaplan-Meier curves were used to estimate the overall survival (OS). Three-months landmark competing risk cumulative incidence curves were used to estimate the cancer specific mortality (CSM). Multivariable Cox regression models (MCR) were used to assess the association of treatment and pathology response (complete response [pCR], partial response [pPR] and pN0) with any cause death and cancer specific death.

RESULTS

A total of 589 patients met the inclusion criteria, with 189 (32%) receiving preoperative systemic treatment (PST) and 115 (20%) undergoing RC + adjuvant therapy (AT). Median follow-up was 32 months. Three-year OS was 69% for PST + RC, 55% for RC + AT, and 55% for RC alone. PST + RC (HR: 0.67, P = .042) was associated with a lower risk of all-cause mortality at MCR. The 3-year CSM was 28% for PST + RC, 38% for RC + AT, and 32% for RC alone. Achieving pCR (HR: 0.31, P = .004), pPR (HR: 0.35, P < .001), and pN0 (HR: 0.44, P < .001) was associated with significantly lower risks of both all-cause and cancer-specific mortality.

CONCLUSIONS

Patients with cN+ BCa undergoing surgery show varied oncological outcomes. Those receiving PST and AT had longer OS, highlighting the importance of systemic therapy. The prognostic value of pCR, pPR, and pN0 supports the need for refined risk stratification to guide preoperative treatment and personalize care.

摘要

引言与目的

临床淋巴结阳性（cN+）膀胱癌（BCa）患者构成了一个生物学特性和预后各不相同的群体。随着全身治疗重塑了这一情况下的治疗模式，本研究探讨了接受或未接受围手术期全身治疗的根治性膀胱切除术（RC）后的肿瘤学结局。

材料与方法

我们利用了一个多中心回顾性收集的数据库，该数据库包含1067例诊断为cTanyN+M0 BCa且接受了伴有或不伴有围手术期全身治疗的淋巴结清扫术的RC患者。纳入了2006年至2023年期间接受治疗的cN1 - 2期疾病患者。采用三个月时间点的Kaplan - Meier曲线来估计总生存期（OS）。采用三个月时间点的竞争风险累积发病率曲线来估计癌症特异性死亡率（CSM）。使用多变量Cox回归模型（MCR）来评估治疗和病理反应（完全缓解[pCR]、部分缓解[pPR]和pN0）与任何原因死亡和癌症特异性死亡之间的关联。

结果

共有589例患者符合纳入标准，其中189例（32%）接受了术前全身治疗（PST），115例（20%）接受了RC + 辅助治疗（AT）。中位随访时间为32个月。PST + RC组的三年OS为69%，RC + AT组为55%，单纯RC组为55%。在MCR中，PST + RC（风险比：0.67，P = 0.042）与全因死亡率较低相关。PST + RC组的三年CSM为28%，RC + AT组为38%，单纯RC组为32%。实现pCR（风险比：0.31，P = 0.004）、pPR（风险比：0.35，P < 0.001）和pN0（风险比：0.44，P < 0.001）与全因和癌症特异性死亡率显著降低相关。