Refining patient selection for neoadjuvant chemotherapy before radical cystectomy.
Refining patient selection for neoadjuvant chemotherapy before radical cystectomy.
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DOI：
10.1016/j.juro.2013.07.061
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发表时间：
2014-01
影响因子：
6.6
通讯作者：
Dinney, Colin P. N.
中科院分区：
文献类型：
--
作者：
Culp, Stephen H.;Dickstein, Rian J.;Grossman, H. Barton;Pretzsch, Shanna M.;Porten, Sima;Daneshmand, Siamak;Cai, Jie;Groshen, Susan;Siefker-Radtke, Arlene;Millikan, Randall E.;Czerniak, Bogdan;Navai, Neema;Wszolek, Matthew F.;Kamat, Ashish M.;Dinney, Colin P. N.
我们评估了未接受新辅助化疗而行根治性膀胱切除术的肌层浸润性膀胱癌患者的生存率，以确认现有临床工具用于识别可单独接受根治性膀胱切除术的低风险患者以及最可能从新辅助化疗中获益的高风险组的有效性。
我们确定了2000年至2010年间在我们机构中未接受新辅助化疗而行根治性膀胱切除术的肌层浸润性膀胱癌患者。根据临床存在的肾积水、cT3b - T4a期疾病和/或经尿道切除术中淋巴血管浸润、微乳头或神经内分泌特征的组织学证据，将患者视为高风险。我们评估了生存率（疾病特异性生存率、无进展生存率和总生存率）以及病理分期升级率。使用来自另一家机构的独立患者队列来证实我们的发现。
我们确定了98例高风险患者和199例低风险患者符合分析条件。与低风险患者相比，高风险患者的5年总生存率（47.0%对64.8%）降低，疾病特异性生存率（64.3%对83.5%）和无进展生存率（62.0%对84.1%）也降低（p <0.001）。在验证子集中证实了生存结果。在最终病理检查中，49.2%的低风险患者疾病分期升级。
低风险患者的5年疾病特异性生存率大于80%，这支持了对高风险和低风险肌层浸润性膀胱癌的区分。高风险特征的存在可识别出预后不良且最可能从新辅助化疗中获益的患者，而许多低风险疾病患者可以预先进行手术且预期良好，并避免化疗相关的毒性。
We evaluated the survival of patients with muscle invasive bladder cancer undergoing radical cystectomy without neoadjuvant chemotherapy to confirm the utility of existing clinical tools to identify low risk patients who could be treated with radical cystectomy alone and a high risk group most likely to benefit from neoadjuvant chemotherapy. We identified patients with muscle invasive bladder cancer who underwent radical cystectomy without neoadjuvant chemotherapy at our institution between 2000 and 2010. Patients were considered high risk based on the clinical presence of hydroureteronephrosis, cT3b-T4a disease, and/or histological evidence of lymphovascular invasion, micropapillary or neuroendocrine features on transurethral resection. We evaluated survival (disease specific, progression-free and overall) and rate of pathological up staging. An independent cohort of patients from another institution was used to confirm our findings. We identified 98 high risk and 199 low risk patients eligible for analysis. High risk patients exhibited decreased 5-year overall survival (47.0% vs 64.8%) and decreased disease specific (64.3% vs 83.5%) and progression-free (62.0% vs 84.1%) survival probabilities compared to low risk patients (p <0.001). Survival outcomes were confirmed in the validation subset. On final pathology 49.2% of low risk patients had disease up staged. The 5-year disease specific survival of low risk patients was greater than 80%, supporting the distinction of high risk and low risk muscle invasive bladder cancer. The presence of high risk features identifies patients with a poor prognosis who are most likely to benefit from neoadjuvant chemotherapy, while many of those with low risk disease can undergo surgery up front with good expectations and avoid chemotherapy associated toxicity.
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影响因子：
6.2
作者：
Raj, Ganesh V.;Karavadia, Saumil;Frenkel, Eugene
通讯作者：
Frenkel, Eugene
影响因子：
158.5
作者：
Grossman, HB;Natale, RB;Crawford, ED
通讯作者：
Crawford, ED
影响因子：
45.3
作者：
Millikan, R;Dinney, C;Logothetis, C
通讯作者：
Logothetis, C
DOI：
10.1016/s1078-1439(03)00148-0
发表时间：
2003-11-01
影响因子：
2.7
作者：
Millikan, R;Siefker-Radtke, A;Grossman, HB
通讯作者：
Grossman, HB
影响因子：
23.4
作者：
Lynch, Siobhan P.;Shen, Yu;Siefker-Radtke, Arlene
通讯作者：
Siefker-Radtke, Arlene