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.	殷小涛, 高江平. 膀胱肿瘤靶向治疗现状及研究进展. 解放军医学院学报, 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, 金讯波. 肌层浸润性膀胱癌的治疗现状. 泌尿外科杂志: 电子版, 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, 袁建华, 杨文铎, 等. 浸润性膀胱癌术前动脉化疗的疗效分析. 中华泌尿外科杂志, 2003, 24(8): 542-544.
7.	林建群, 章锐鸿, 陈锡彬, 等. 新辅助化疗后局部转移性膀胱癌患者行根治性切除术的临床研究. 国际泌尿系统杂志, 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.	张鑫, 肖博, 陈松, 等. 吉西他滨与顺铂新辅助化疗治疗肌层浸润性膀胱癌疗效观察. 中华实验外科杂志, 2015, 32(6): 1451-1453.
10.	柳影, 程颖. 实体肿瘤疗效评价标准的研究. 实用肿瘤学杂志, 2004, 18(2): 149-152.
11.	皋文君, 刘砚燕, 袁长蓉. 国际肿瘤化疗药物不良反应评价系统——通用不良反应术语标准 4.0 版. 肿瘤, 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. 应重视化疗在肌层浸润性膀胱癌保留膀胱治疗中的作用. 首都医科大学学报, 2014, 35(3): 269-272.
16.	尹志康, 吴小候, 苟欣, 等. 手术方式对保留膀胱的膀胱移行细胞癌患者预后的影响. 重庆医科大学学报, 2007, 32(1): 67-68, 71.
17.	张国辉, 王金萍, 郑清友, 等. 肌层浸润性膀胱癌保留膀胱手术后不同辅助治疗方法的疗效评价. 现代泌尿外科杂志, 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. 殷小涛, 高江平. 膀胱肿瘤靶向治疗现状及研究进展. 解放军医学院学报, 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, 金讯波. 肌层浸润性膀胱癌的治疗现状. 泌尿外科杂志: 电子版, 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, 袁建华, 杨文铎, 等. 浸润性膀胱癌术前动脉化疗的疗效分析. 中华泌尿外科杂志, 2003, 24(8): 542-544.
7. 林建群, 章锐鸿, 陈锡彬, 等. 新辅助化疗后局部转移性膀胱癌患者行根治性切除术的临床研究. 国际泌尿系统杂志, 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. 张鑫, 肖博, 陈松, 等. 吉西他滨与顺铂新辅助化疗治疗肌层浸润性膀胱癌疗效观察. 中华实验外科杂志, 2015, 32(6): 1451-1453.
10. 柳影, 程颖. 实体肿瘤疗效评价标准的研究. 实用肿瘤学杂志, 2004, 18(2): 149-152.
11. 皋文君, 刘砚燕, 袁长蓉. 国际肿瘤化疗药物不良反应评价系统——通用不良反应术语标准 4.0 版. 肿瘤, 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. 应重视化疗在肌层浸润性膀胱癌保留膀胱治疗中的作用. 首都医科大学学报, 2014, 35(3): 269-272.
16. 尹志康, 吴小候, 苟欣, 等. 手术方式对保留膀胱的膀胱移行细胞癌患者预后的影响. 重庆医科大学学报, 2007, 32(1): 67-68, 71.
17. 张国辉, 王金萍, 郑清友, 等. 肌层浸润性膀胱癌保留膀胱手术后不同辅助治疗方法的疗效评价. 现代泌尿外科杂志, 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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