Efficacy of Bladder-Preserving Therapy for Patients with T3b, T4a, and T4b Transitional Cell Carcinoma of the Bladder.
10.4111/kju.2010.51.8.525
- Author:
Jaewoo CHEON
1
;
Hyunchul CHUNG
;
Jaemann SONG
Author Information
1. Department of Urology, Wonju Christian Hospital, Wonju Yonsei College of Medicine, Wonju, Korea. jmsong@yonsei.ac.kr
- Publication Type:Original Article
- Keywords:
Drug therapy;
Therapeutics;
Urinary bladder neoplasms
- MeSH:
Carcinoma, Transitional Cell;
Cisplatin;
Cystectomy;
Deoxycytidine;
Follow-Up Studies;
Humans;
Hydronephrosis;
Multivariate Analysis;
Quality of Life;
Survival Rate;
Urinary Bladder;
Urinary Bladder Neoplasms
- From:Korean Journal of Urology
2010;51(8):525-530
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Radical cystectomy has been the most widely used method in the treatment of bladder cancer, but it is limited by major problems. Therefore, we investigated the results of bladder-preserving treatment in patients with T3b, T4a, and T4b transitional carcinoma of the bladder who underwent transurethral resection of bladder cancer and subsequent administration of chemotherapy. MATERIALS AND METHODS: Of all patients who were diagnosed with bladder cancer and underwent bladder-preserving treatment between January 2001 and August 2008, 78 patients with at least 12 months of follow-up data were enrolled in this study. All patients received gemcitabine (1,000 mg/m2) and cisplatin (70 mg/m2) once per month postoperatively for a total of 6 months and completed a follow-up visit every 3 months. The patient survival rate and prognostic factors (age, tumor size, differentiation, number of lesions, stage, and presence of hydronephrosis) were assessed. The Kaplan-Meier method was used to analyze survival rate, and Cox multiple regression analysis was used for prognostic factors. RESULTS: The mean patient age was 68.32+/-8.6 years, the mean duration of follow-up was 54.70+/-32.8 months, and the median duration of follow-up was 49.0 months. The 5-year survival rate was 66.2%. Single lesions were found in 28 cases (35.9%), and multiple lesions were found in 50 cases (64.1%). Stage T3b lesions were identified in 56 cases (71.8%), stage T4a lesions were identified in 16 cases (20.5%), and stage T4b lesions were identified in 6 cases (7.7%). Tumor size was less than 4 cm in 4 cases (59.0%) and greater than 4 cm in 32 (41.0%). Hydronephrosis was present in 21 cases (26.9%). In the 5-year survival analysis, prognostic factors significantly influencing survival rate were T-stage of the tumor and absence of hydronephrosis and complete regression after treatment (p<0.05). Multivariate analysis revealed that tumor stage and the absence of hydronephrosis were statistically significant prognostic indicators. CONCLUSIONS: In patients with T3b, T4a, and T4b transitional carcinoma of the bladder, bladder preservation may prevent a decrease in quality of life. Also, our findings suggest that this approach could be considered a primary treatment option for patients with T3b stage tumors without evidence of hydronephrosis.
