Bladder-sparing treatment following noninvasive down-staging after transurethral resection of bladder tumor plus systemic chemotherapy for muscle-invasive bladder cancer
10.3760/cma.j.cn112330-20220524-00308
- VernacularTitle:最大限度TURBT联合全身化疗后明显降期的MIBC保留膀胱综合治疗长期疗效和安全性
- Author:
Youyan GUAN
1
;
Xingang BI
;
Jun TIAN
;
Zhendong XIAO
;
Zejun XIAO
;
Dong WANG
;
Kaopeng GUAN
;
Hongzhe SHI
;
Linjun HU
;
Chuanzhen CAO
;
Jie WU
;
Changling LI
;
Jianhui MA
;
Yueping LIU
;
Aiping ZHOU
;
Jianzhong SHOU
Author Information
1. 国家癌症中心/国家肿瘤临床医学中心/中国医学科学院 北京协和医学院肿瘤医院泌尿外科，北京 100021
- Keywords:
Urinary bladder neoplasm;
Muscle-invasive bladder cancer;
Bladder-sparing treatment;
Concurrent chemoradiotherapy;
Prognosis
- From:
Chinese Journal of Urology
2022;43(6):411-415
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the long-term survival and safety in patients with muscle-invasive bladder cancer (MIBC) who experienced a noninvasive down-staging (≤pT 1)after transurethral resection of bladder tumor (TURBT) plus systemic chemotherapy and received bladder-sparing treatment. Methods:The records of patients with MIBC who underwent maximal TURBT plus systemic chemotherapy-guided bladder-sparing treatment were reviewed retrospectively from Dec 2013 to Dec 2020. Eventually, 22 patients who achieved noninvasive down-staging underwent conservative management. The total patient cohort contained 10 males and 12 females. A majority of patients had single lesion and stage T2 disease. The median age of the patients was 66 years and the median tumor size was 3.0 cm. All patients underwent maximal TURBT to resect all visible diseases and followed by 3-4 cycles platinum-based systemic chemotherapy. After achieving noninvasive down-staging, 14 patients received concurrent chemoradiotherapy, and the other 8 patients underwent surveillance. Overactive bladder symptom score (OABSS) was used to assess the bladder function after treatment.Results:Twelve patients achieved pT 0 and 10 patients were down-staged to cT a-T 1. At a median follow-up of 36.7 months, 90.9%(20/22) patients retained their bladder function successfully. Among the 14 patients who received concurrent chemoradiotherapy, 4 had grade 3 or 4 adverse events. Among the 8 patients who underwent surveillance, 3 had grade 3 or 4 adverse events after systemic chemotherapy.Nine patients experienced tumor recurrence in the bladder, and 2 patients died of bladder cancer. Seven (31.8%) patients experienced Ⅲ/Ⅳ grade complications. The 5-year recurrence-free survival (RFS) and overall survival (OS) in patients achieved pT0 were 66.7% and 100.0%, respectively. The 5-year RFS and OS in patients achieved cTa-T1 were 40% and 72%, respectively. The OABSS score of 20 patients who retained their bladder successfully was (1.00±1.03). Conclusions:MIBC patients who achieved noninvasive down-staging might be candidates for the bladder-sparing treatment with maximum TURBT followed by systemic chemotherapy.The patients who achieved pT 0 might have better prognosis with functional bladder.
