Benefit of Adjuvant Chemotherapy and Pelvic Lymph Node Dissection in pT3 and Node Positive Bladder Cancer Patients Treated with Radical Cystectomy.
Benefit of Adjuvant Chemotherapy and Pelvic Lymph Node Dissection in pT3 and Node Positive Bladder Cancer Patients Treated with Radical Cystectomy.
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DOI：
10.3233/blc-150032
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发表时间：
2016-04-27
期刊：
影响因子：
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通讯作者：
Zlotta AR
中科院分区：
文献类型：
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作者：
Boström PJ;Mirtti T;van Rhijn B;Fleshner NE;Finelli A;Laato M;Jewett MA;Moore MJ;Sridhar S;Nurmi M;Tannock IF;Zlotta AR
背景：在根治性膀胱切除术(RC)中，辅助化疗(AC)和盆腔淋巴结清扫范围(PLND)的益处一直存在争议。随机试验的结果仍在预料之中。目的：分析AC和PLND在两个不同使用政策的学术中心的效果。方法：来自加拿大多伦多(大学卫生网络)和芬兰图尔库大学医院的581名未接受新辅助化疗的膀胱癌患者接受RC治疗。评估疾病特异性存活期(DSS)和失败模式。结果：不同中心的淋巴结清扫率不同(多伦多和图尔库分别为93%和36%，p <； 0.001)，淋巴结转移范围(≥10个切除结节，58%vs.8%，p <； 0.001)和AC率(21%vs.2%，p <； 0.001)。PT1和≤4患者的中心间存活率相似。在多伦多，PT3患者的10年DSS得到了改善(43%比22%，p = 0.025)。AC治疗后远距离心力衰竭较少见(HR 0.56，95% CI 0.33-0.98，p <； 0.042)。在淋巴结阳性(N+)患者中，图尔库组的死亡率显著高于对照组(HR2.19，95% CI1.44~3.34，p <； 0.001)，而接受AC治疗的患者死亡率较低(HR0.60，95% CI0.37~0.99，p = 0.044)。在多伦多N+ 患者中，10年后41%的患者有DSS。局限性包括非随机化的回溯性设计和缺乏倾向评分分析。结论：AC+PLND联合RC可提高PT3型和N+ 患者的生存率。PLND并不独立影响患者的生存，但有助于选择AC患者。我们的数据增加了越来越多的证据，支持除PLND外，AC在接受膀胱切除术的高危患者中的有效性。
Background: Benefits of adjuvant chemotherapy (AC) and extent of pelvic lymph node dissection (PLND) in radical cystectomy (RC) are debated. Results from randomized trials are still expected. Objective: To analyze the effects of AC and PLND in two academic centers with opposite policies regarding their use. Methods: 581 bladder cancer patients who underwent RC without neoadjuvant chemotherapy, from Toronto (University Health Network), Canada, and Turku University Hospital, Finland were included. Disease specific survival (DSS) and failure patterns were assessed. Results: Centers differed in PLND rate (93% and 36% in Toronto and Turku respectively, p < 0.001), PLND extent (≥10 removed nodes, 58% vs. 8%, p < 0.001) and AC rate (21% vs. 2%, p < 0.001). Survival between centers among pT≤1 or pT4 patients was similar. pT3 patients in Toronto had an improved 10 year DSS (43% vs. 22%, p = 0.025). Distant failures were less common after AC (HR 0.56, 95% CI 0.33–0.98, p < 0.042). In node positive (N+) patients, mortality was significantly higher in Turku (HR 2.19, 95% CI 1.44–3.34, p < 0.001) and lower in patients receiving AC (HR 0.60, 95% CI 0.37–0.99, p = 0.044). 41% DSS at 10 years was observed in N+ Toronto patients. Limitations included the non-randomized retrospective design and absence of propensity score analysis. Conclusion: Combining AC and PLND to RC is associated with improved survival in pT3 and N+ patients. PLND did not affect survival independently but helps in selecting patients for AC. Our data adds to the growing body of evidence supporting the usefulness of AC in addition to PLND in high risk patients operated by cystectomy.