肌层浸润性膀胱癌新辅助化疗病理与长期临床结局——单中心15年真实世界临床研究  

Pathologic and long-term outcomes of neoadjuvant chemotherapy for muscle-invasive bladder cancer:a single-center,15-year real-world study

作　　者：张瑞赟 金迪[1] 钱雷 阿克周力 夏骏[2] 曹明[1] 张连华[1] 薛蔚[1] 黄翼然[1] 陈海戈[1] ZHANG Ruiyun;JIN Di;QIAN Lei;Akezhouli;XIA Jun;CAO Ming;ZHANG Lianhua;XUE Wei;HUANG Yiran;CHEN Haige(Department of Urology,Ren Ji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200127,China;Department of Pathology,Ren Ji Hospital,Shanghai Jiao Tong University School of Medicine)

机构地区：[1]上海交通大学医学院附属仁济医院泌尿科,上海200127 [2]上海交通大学医学院附属仁济医院病理科

出　　处：《临床泌尿外科杂志》2023年第12期915-920,共6页Journal of Clinical Urology

基　　金：国家自然科学基金(No:81672514,81902562);上海市科委基金项目(No:16ZR1420300,18410720400,19431907400);上海交通大学医学院基金(No:TM201708);上海交通大学医学院附属仁济医院临床科研创新培育基金(No:RJZZ18-020,PYIII-17-017,PY2018-IIC-02);上海申康医院发展中心项目(No:SHDC12015125)。

摘　　要：目的:报道吉西他滨联合顺铂(GC)方案新辅助化疗联合全膀胱切除术治疗肌层浸润性膀胱癌(muscle-invasive bladder cancer,MIBC)的病理学与长期生存数据。方法:纳入2003—2017年上海交通大学医学院附属仁济医院临床诊断为MIBC、临床分期为cT2~4NanyM0,并行根治性全膀胱切除术的1220例患者进行回顾性分析。按照患者术前是否接受新辅助化疗,分为单纯全膀胱组(RC组,783例)与新辅助联合全膀胱组(NAC组,437例)。对2组的队列特征、总生存期(overall survival,OS),肿瘤特异性生存期(cancer specific survival,CSS)、无复发生存期(recurrence free survival,RFS)、病理缓解率等进行比较。结果:NAC组患者的年龄与RC组相比显著降低;临床分期方面,RC组cT4a期患者比例高于NAC组(10.7%vs 5.7%,P=0.012),但2组cN分期比较差异无统计学意义(P=0.153)。NAC组达到完全病理缓解(complete pathological response,ypCR)的患者共99例(22.6%),达到部分病理缓解(partial pathological response,ypPR)的患者共142例(32.5%),总病理缓解(overall pathological response rate,ypRR)共241例(55.1%)。NAC组5年OS、CSS、RFS率分别为74.4%、76.6%、71.3%,10年OS、CSS、RFS率分别为48.1%、62.5%、55.7%,平均OS、CSS、RFS分别为97.6、108.6、99.2个月。RC组5年OS、CSS、RFS率分别为58.6%、64.1%、54.8%,10年OS、CSS、RFS率分别为46.9%、56.0%、32.7%,平均OS、CSS、RFS分别为89.6、97.5、83.2个月。经倾向性评分匹配后,NAC组的平均OS(P<0.001)、平均CSS(P<0.001)以及平均RFS(P<0.001)均显著优于RC组。结论:GC方案新辅助化疗可以显著改善MIBC患者的预后,使肿瘤通过化疗达到病理降期,延长OS、CSS、RFS。Objective To assess the value of gemcitabine plus cisplatin(GC)neoadjuvant chemotherapy with radical cystectomy in the treatment of patients with muscle-invasive bladder cancer(MIBC).Methods This study included a retrospective analysis of a total of 1220 cases diagnosed as MIBC(cT2-4NanyM0)in Ren Ji Hospital,Shanghai Jiao Tong University School of Medicine from 2003 to 2017.According to whether received neoadjuvant chemotherapy before surgery,all patients were divided into a radical cystectomy group(RC group)and a neoadjuvant chemotherapy group(NAC group),and there were 783 cases in RC group and 437 cases in NAC group.The cohort characteristics,overall survival(OS),cancer specific survival(CSS),recurrence free survival(RFS),and pathological downstage rate of the two groups were compared.Results The age of patients in the NAC group was significantly younger than that in the RC group;In terms of clinical stage,the proportion of patients in the RC group with cT4a was higher than that in the NAC group(10.7%vs 5.7%,P=0.012),but no significant difference was found between the two groups in the cN stage(P=0.153).In the NAC group,99 cases(22.6%)were found complete pathological response(ypCR),142 cases(32.5%)were found ypPR and 241(55.1%)cases were found ypRR.In the NAC group,the 5-year OS,CSS,and RFS rates were 74.4%,76.6%,and 71.3%respectively,the 10-year OS,CSS,and RFS rates were 48.1%,62.5%,and 55.7%respectively,and the average duration of OS,CSS,and RFS were 97.6,108.6,and 99.2 months.In the RC group,the 5-year OS,CSS,and RFS rates respectively were 58.6%,64.1%,and 54.8%,the 10-year OS,CSS,and RFS rates were 46.9%,56.0%,and 32.7%,and the average duration of OS,CSS,and RFS were 89.6,97.5,and 83.2 months.After propensity score matching,NAC group was significantly better than the RC group in average OS(P=0.001),average CSS(P<0.001),and average RFS(P<0.001).Conclusion GC neoadjuvant chemotherapy can improve survival of the patients with MIBC,facilitate tumor downstage and increase the overall survival duration,the recurr

关 键 词：膀胱癌 新辅助化疗 预后 长期随访 

分 类 号：R737.14[医药卫生—肿瘤]