Impact of adjuvant chemotherapy on survival of patients with pT3 bladder urothelial carcinoma after radical cystectomy_West China Medical Journal

Authors：

WANG Juncai ¹ , Gao Weijun ¹ ,  HAN Xiang ² , SUN Xiaodong ³

1. The Second Department of Urology, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyan, Shaanxi 712000, P.R.China;
2. Department of Urology, the People’s Hospital of Hanzhong City, Hanzhong, Shaanxi 723000, P. R. China;
3. Department of Oncology, Affiliated Hospital of Yan’an University, Yan’an, Shaanxi 716000, P. R. China;

Corresponding?author：

HAN Xiang, Email: sxcghx@sinz.com

Keywords：

Urothelial carcinoma; Perivesical tissue invasion; Radical cystectomy; Survival; Adjuvant chemotherapy

DOI：

10.7507/1002-0179.201605235

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Objective To assess the impact of adjuvant chemotherapy (ACH) on the survival of patients with pT3 urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC). Methods We retrospectively analyzed the clinical and follow-up data of 223 UCB patients who underwent RC between January 2005 and June 2015. None of the patients received neoadjuvant chemotherapy. Of all the patients, 75 (33.6%) were diagnosed as pT3 cancer (including 32 pT3a and 43 pT3b patients). The follow-up data were up to June 2015. Kaplan-Meier method with log-rank test was used to estimate and compare overall survival (OS) and cancer-specific survival (CSS) between groups. Multivariate Cox proportional hazard models were used to identify predictors of OS and CSS. Results The short-term total effective rate of gemcitabine and cisplatin assisted chemotherapy in the treatment of pT3 UCB was 60.0%. Five-year OS rate (47.9%vs. 43.3%) and CSS rate (57.4%vs. 57.6%) were similar in the pT3a and pT3b groups (P=0.682 and 0.796, respectively). In pT3 patients, adjuvant chemotherapy was an independent predictor for OS (P=0.032). On multivariate analysis, according to the pT3 sub-stage, ACH was significantly associated with improved OS [hazard ratio (HR) =0.37; 95% confidence interval (CI) (0.15, 0.68),P=0.006] and CSS [HR=0.34, 95%CI (0.12, 0.86),P=0.022] in the pT3b group only. Conclusion Because pT3b cancer is characterized by macroscopic peri-vesical tissue invasion, patients may obtain an OS benefit from the administration of adjuvant chemotherapy.

Citation： WANG Juncai, Gao Weijun, HAN Xiang, SUN Xiaodong. Impact of adjuvant chemotherapy on survival of patients with pT3 bladder urothelial carcinoma after radical cystectomy. West China Medical Journal, 2017, 32(4): 534-540. doi: 10.7507/1002-0179.201605235 Copy

1.	?殷小濤, 高江平. 膀胱腫瘤靶向治療現狀及研究進展. 解放軍醫學院學報, 2017(1): 75-78.
2.	Moschini M, Karnes R J, Sharma V, et al. Patterns and prognostic significance of clinical recurrences after radical cystectomy for bladder cancer: a 20-year single center experience. Eur J Surg Oncol, 2016, 42(5): 735-743.
3.	陶逸然, 金訊波. 肌層浸潤性膀胱癌的治療現狀. 泌尿外科雜志: 電子版, 2014(3): 36-40.
4.	Boudreaux KJ, Chang SS, Lowrance WT, et al. Comparison of American joint committee on cancer pathologic stage T3aversus T3b urothelial carcinoma: analysis of patient outcomes. Cancer, 2009, 115(4): 770-775.
5.	Scosyrev E, Yao J, Messing E. Microscopic invasion of perivesical fat by urothelial carcinoma: implications for prognosis and pathology practice. Urology, 2010, 76(4): 908-913; discussion 914.
6.	周俊, 袁建華, 楊文鐸, 等. 浸潤性膀胱癌術前動脈化療的療效分析. 中華泌尿外科雜志, 2003, 24(8): 542-544.
7.	林建群, 章銳鴻, 陳錫彬, 等. 新輔助化療后局部轉移性膀胱癌患者行根治性切除術的臨床研究. 國際泌尿系統雜志, 2016, 36(4): 488-489.
8.	Grossman HB, Natale RB, Tangen CM, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med, 2003, 349(9): 859-866.
9.	張鑫, 肖博, 陳松, 等. 吉西他濱與順鉑新輔助化療治療肌層浸潤性膀胱癌療效觀察. 中華實驗外科雜志, 2015, 32(6): 1451-1453.
10.	柳影, 程穎. 實體腫瘤療效評價標準的研究. 實用腫瘤學雜志, 2004, 18(2): 149-152.
11.	皋文君, 劉硯燕, 袁長蓉. 國際腫瘤化療藥物不良反應評價系統——通用不良反應術語標準 4.0 版. 腫瘤, 2012, 32(2): 142-144.
12.	Tilki D, Svatek RS, Karakiewicz PI, et al. pT3 substaging is a prognostic indicator for lymph node negative urothelial carcinoma of the bladder. J Urol, 2010, 184(2): 470-474.
13.	Neuzillet Y, Lebret T, Molinie V, et al. Perivesical fat invasion in bladder cancer: implications for prognosis comparing pT2b, pT3a and pT3b stages and consequences for adjuvant chemotherapy indications. BJU Int, 2012, 110(11): 1736-1741.
14.	Dincel C, Kara C, Balci U, et al. Comparison of microscopic (pT3a) and gross extravesical extension (pT3b) in pathological staging of bladder cancer: analysis of patient outcomes. Int Urol Nephrol, 2013, 45(2): 387-393.
15.	田野. 應重視化療在肌層浸潤性膀胱癌保留膀胱治療中的作用. 首都醫科大學學報, 2014, 35(3): 269-272.
16.	尹志康, 吳小候, 茍欣, 等. 手術方式對保留膀胱的膀胱移行細胞癌患者預后的影響. 重慶醫科大學學報, 2007, 32(1): 67-68, 71.
17.	張國輝, 王金萍, 鄭清友, 等. 肌層浸潤性膀胱癌保留膀胱手術后不同輔助治療方法的療效評價. 現代泌尿外科雜志, 2013, 18(6): 557-561.
18.	Kim HS, Piao S, Moon KC, et al. Adjuvant chemotherapy correlates with improved survival after radical cystectomy in patients with pT3b (macroscopic perivesical tissue invasion) bladder cancer. J Cancer, 2015, 6(8): 750-758.

1. ?殷小濤, 高江平. 膀胱腫瘤靶向治療現狀及研究進展. 解放軍醫學院學報, 2017(1): 75-78.
2. Moschini M, Karnes R J, Sharma V, et al. Patterns and prognostic significance of clinical recurrences after radical cystectomy for bladder cancer: a 20-year single center experience. Eur J Surg Oncol, 2016, 42(5): 735-743.
3. 陶逸然, 金訊波. 肌層浸潤性膀胱癌的治療現狀. 泌尿外科雜志: 電子版, 2014(3): 36-40.
4. Boudreaux KJ, Chang SS, Lowrance WT, et al. Comparison of American joint committee on cancer pathologic stage T3aversus T3b urothelial carcinoma: analysis of patient outcomes. Cancer, 2009, 115(4): 770-775.
5. Scosyrev E, Yao J, Messing E. Microscopic invasion of perivesical fat by urothelial carcinoma: implications for prognosis and pathology practice. Urology, 2010, 76(4): 908-913; discussion 914.
6. 周俊, 袁建華, 楊文鐸, 等. 浸潤性膀胱癌術前動脈化療的療效分析. 中華泌尿外科雜志, 2003, 24(8): 542-544.
7. 林建群, 章銳鴻, 陳錫彬, 等. 新輔助化療后局部轉移性膀胱癌患者行根治性切除術的臨床研究. 國際泌尿系統雜志, 2016, 36(4): 488-489.
8. Grossman HB, Natale RB, Tangen CM, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med, 2003, 349(9): 859-866.
9. 張鑫, 肖博, 陳松, 等. 吉西他濱與順鉑新輔助化療治療肌層浸潤性膀胱癌療效觀察. 中華實驗外科雜志, 2015, 32(6): 1451-1453.
10. 柳影, 程穎. 實體腫瘤療效評價標準的研究. 實用腫瘤學雜志, 2004, 18(2): 149-152.
11. 皋文君, 劉硯燕, 袁長蓉. 國際腫瘤化療藥物不良反應評價系統——通用不良反應術語標準 4.0 版. 腫瘤, 2012, 32(2): 142-144.
12. Tilki D, Svatek RS, Karakiewicz PI, et al. pT3 substaging is a prognostic indicator for lymph node negative urothelial carcinoma of the bladder. J Urol, 2010, 184(2): 470-474.
13. Neuzillet Y, Lebret T, Molinie V, et al. Perivesical fat invasion in bladder cancer: implications for prognosis comparing pT2b, pT3a and pT3b stages and consequences for adjuvant chemotherapy indications. BJU Int, 2012, 110(11): 1736-1741.
14. Dincel C, Kara C, Balci U, et al. Comparison of microscopic (pT3a) and gross extravesical extension (pT3b) in pathological staging of bladder cancer: analysis of patient outcomes. Int Urol Nephrol, 2013, 45(2): 387-393.
15. 田野. 應重視化療在肌層浸潤性膀胱癌保留膀胱治療中的作用. 首都醫科大學學報, 2014, 35(3): 269-272.
16. 尹志康, 吳小候, 茍欣, 等. 手術方式對保留膀胱的膀胱移行細胞癌患者預后的影響. 重慶醫科大學學報, 2007, 32(1): 67-68, 71.
17. 張國輝, 王金萍, 鄭清友, 等. 肌層浸潤性膀胱癌保留膀胱手術后不同輔助治療方法的療效評價. 現代泌尿外科雜志, 2013, 18(6): 557-561.
18. Kim HS, Piao S, Moon KC, et al. Adjuvant chemotherapy correlates with improved survival after radical cystectomy in patients with pT3b (macroscopic perivesical tissue invasion) bladder cancer. J Cancer, 2015, 6(8): 750-758.

West China Medical Journal

Impact of adjuvant chemotherapy on survival of patients with pT3 bladder urothelial carcinoma after radical cystectomy

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