Sahwi A, Robert M, Delbos O, Legouffe E, Guiter J, Navratil H
Service d'Urologie I, Hôpital Lapeyronie, CHU de Montpellier, France.
Prog Urol. 1998 Dec;8(6):1007-11.
To evaluate the prognosis of stage pT3bM0 invasive urothelial bladder tumours treated by cystectomy alone or combined with adjuvant chemotherapy according to the MVAC protocol (methotrexate, vinblastine, adriamycin and cisplatin).
From 1987 to 1996, 90 patients with stage pT3M0 urothelial bladder tumours were treated with isolated cystectomy (n = 69) or followed by MVAC chemotherapy (n = 21). Lymph node stage was N0 (n = 55), N+ (n = 29) or Nx (n = 6). Essentially selected because of their good general status, patients treated with chemotherapy had a lymph node stage N0 (n = 7) or N+ (n = 14). Chemotherapy had to be suspended in 2 cases and with a fatal outcome during treatment in 4 cases, due to tumour progression, surgical complication or bone marrow aplasia.
65 deaths have occurred with a follow-up of 2 to 120 months (m = 15), including 2 postoperative deaths, 39 cancer deaths and 14 intercurrent deaths. The 1-year, 2-year and 5-year actuarial survival rates were 70%, 48% and 19% for stage N0 and 54%, 25% and 3% for stage N+, respectively, with corresponding median survivals of 20 and 12 months (p < 0.005). The recurrence rate increased from 40% at stage N0 to 62% at stage N+ (p = 0.05), and the corresponding recurrence-free survivals were 16 months and 7 months (p < 0.02). The median survival without chemotherapy ranged from 11 months at stage N+ to 20 months at stage N0 and, with chemotherapy, from 19 months at stage N+ to 67 months at stage N0. The median recurrence-free survival with and without chemotherapy, was 43 months and 17 months at stage N0 and 12 months and 7 months at stage N+.
The prognosis after cystectomy for stage pT3b bladder cancer is severe, especially in the presence of lymph node involvement. Adjuvant chemotherapy according to the MVAC protocol tends to improve survival, especially recurrence-free survival, and appears beneficial at stage N0. However, the value of this adjuvant treatment, which is associated with a high specific morbidity appears to be more relative at stage N+.
评估单纯膀胱切除术或联合按照MVAC方案（甲氨蝶呤、长春碱、阿霉素和顺铂）进行辅助化疗的pT3bM0期浸润性膀胱尿路上皮肿瘤的预后。
1987年至1996年，90例pT3M0期膀胱尿路上皮肿瘤患者接受了单纯膀胱切除术（n = 69）或术后MVAC化疗（n = 21）。淋巴结分期为N0（n = 55）、N+（n = 29）或Nx（n = 6）。接受化疗的患者主要因其一般状况良好而入选，其淋巴结分期为N0（n = 7）或N+（n = 14）。2例患者化疗不得不中止，4例患者在治疗期间因肿瘤进展、手术并发症或骨髓再生障碍而死亡。
随访2至120个月（中位数 = 15个月）期间发生65例死亡，包括2例术后死亡、39例癌症死亡和14例并发疾病死亡。N0期的1年、2年和5年精算生存率分别为70%、48%和19%，N+期分别为54%、25%和3%，相应的中位生存期分别为20个月和12个月（p < 0.005）。复发率从N0期的40%升至N+期的62%（p = 0.05），相应的无复发生存期分别为16个月和7个月（p < 0.02）。未接受化疗的中位生存期，N+期为11个月，N0期为20个月；接受化疗的，N+期为19个月，N0期为67个月。N0期接受和未接受化疗的中位无复发生存期分别为43个月和17个月，N+期分别为12个月和7个月。
pT3b期膀胱癌膀胱切除术后预后较差，尤其是存在淋巴结受累时。按照MVAC方案进行辅助化疗倾向于提高生存率，尤其是无复发生存率，且在N0期似乎有益。然而，这种辅助治疗的价值与高特异性发病率相关，在N+期似乎相对更有限。
