Could salvage surgery after chemotherapy have clinical impact on cancer survival of patients with metastatic urothelial carcinoma?
Could salvage surgery after chemotherapy have clinical impact on cancer survival of patients with metastatic urothelial carcinoma?
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DOI：
10.1007/s10147-011-0350-z
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发表时间：
2013-02-01
影响因子：
3.3
通讯作者：
Kumon, Hiromi
中科院分区：
文献类型：
--
作者：
Bekku, Kensuke;Saika, Takashi;Kumon, Hiromi
化疗后挽救性手术对转移性尿路上皮癌患者癌症生存率的临床影响存在争议。我们的目的是通过分析接受化疗的尿路上皮癌患者的长期结局来验证挽救手术的临床作用。在2003年至2010年期间，在一家机构，47例转移性尿路上皮癌患者中有31例（66%）显示出客观缓解回顾性入组了多个疗程的顺铂/吉西他滨/紫杉醇化疗后的CR（4例），PR（27例）和部分缓解（PR）患者队列。27例PR患者中有12例（10例男性和2例女性，中位年龄64.0岁）在化疗后接受了挽救性手术：残留病灶的转移性切除术（10个腹膜后淋巴结，2个肺），以及6例原发病灶的根治性手术。回顾性分析无进展生存率和总生存率，并与未行挽救手术的患者进行比较，12例患者均达到手术CR。3例转移灶的病理结果显示有存活的癌细胞。在单因素分析中，单一挽救手术影响27例化疗PR患者的总生存率（P = 0.0037）。挽救性手术患者的无进展生存率和总生存率优于15例未手术的PR患者（3年时39.8 vs. 0%和71.6 vs. 12.1%，P = 0.01032和0.01048;对于对化疗达到部分反应的具有残留肿瘤的患者的挽救手术可能对癌症存活具有可能的影响。
The clinical impact of salvage surgery after chemotherapy on cancer survival of patients with metastatic urothelial carcinoma is controversial. We aimed to verify the clinical role of salvage surgery by analyzing the long-term outcome in patients with urothelial carcinoma treated by chemotherapy.Between 2003 and 2010 at a single institution, 31 of 47 patients (66%) with metastatic urothelial carcinoma showed objective responses (CR in 4, PR in 27) after multiple courses of cisplatin/gemcitabine/paclitaxel-based chemotherapy, and a cohort of patients with partial response (PR) were retrospectively enrolled. Twelve (10 male and 2 female, median age 64.0 years) of 27 patients with PR underwent salvage surgeries after the chemotherapy: metastatectomy of residual lesions (10 retroperitoneal lymph nodes, 2 lung), and 6 radical surgeries for primary lesions as well. Progression-free survival and overall patient survival rates were analyzed retrospectively and compared with those of patients without salvage surgery.All 12 patients achieved surgical CR. Pathological findings of metastatic lesions showed viable cancer cells in 3 patients. In univariate analysis, sole salvage surgery affected overall survival in 27 patients with PR to the chemotherapy (P = 0.0037). Progression-free survival and overall survival rates in patients with salvage surgery were better than those in 15 PR patients without the surgery (39.8 vs. 0%, and 71.6 vs. 12.1% at 3 years, P = 0.01032 and 0.01048; log-rank test).Salvage surgery for patients with residual tumor who achieve partial response to chemotherapy could have a possible impact on cancer survival.