Radical Cystectomy for Bladder Cancer in Patients With and Without a History of Pelvic Irradiation: Survival Outcomes and Diversion-related Complications
Radical Cystectomy for Bladder Cancer in Patients With and Without a History of Pelvic Irradiation: Survival Outcomes and Diversion-related Complications
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DOI：
10.1016/j.urology.2015.02.061
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发表时间：
2015-07-01
期刊：
影响因子：
2.1
通讯作者：
Scherr, Douglas S.
中科院分区：
文献类型：
--
作者：
Nguyen, Daniel P.;Al Awamlh, Bashir Al Hussein;Scherr, Douglas S.
目的比较有盆腔放疗史和无盆腔放疗史的根治性膀胱切除术患者的生存结局和转移相关并发症。患者和方法从2001年7月到2013年9月，364例膀胱癌（BCa）患者接受了根治性膀胱切除术。37例（10%）患者有盆腔放疗史，327例（90%）患者没有盆腔放疗史。采用Kaplan-Meier法和Cox回归模型评价生存结局。将转移相关并发症制成表格。结果放疗组非器官局限性疾病的比例高于未放疗组（37例患者中有18例[49%]vs 327例患者中有117例[36%]，P = 0.1）。两组患者T4病变比例差异有统计学意义（37例放疗患者中13例[35%]vs 327例未放疗患者中37例[11%]，P = 0.005）。37例放疗患者中有7例不能进行盆腔淋巴结清扫。非尿路上皮癌组织学在放疗组比未放疗组更常见（37例中有5例[14%]vs 327例中有19例[6%]，P = 0.003）。3年时，放疗和未放疗患者的BCa无复发生存率分别为70 +/- 9%和77 +/- 3% (log-rank P = 0.5)， BCa特异性生存率分别为64 +/- 9%和69 +/- 3% （log-rank P = 0.4）。在多变量分析中，盆腔放疗史不能预测BCa复发或BCa特异性死亡。两组间转移相关并发症发生率无差异。结论有盆腔放疗史的BCa患者病情更严重。在这组患者中，手术仍然困难，因为大约五分之一的患者省略了盆腔淋巴结清扫。在一定范围内，既往盆腔照射不能预测生存结果。(C) 2015爱思唯尔公司
OBJECTIVE To compare survival outcomes and diversion-related complications of patients with and without a history of pelvic irradiation who underwent radical cystectomy.PATIENTS AND METHODS Three hundred sixty-four patients underwent radical cystectomy for bladder cancer (BCa) from July 2001 to September 2013. Thirty-seven patients (10%) had a history of pelvic irradiation, and 327 (90%) did not. The Kaplan-Meier method and Cox regression models were applied to evaluate survival outcomes. Diversion-related complications were tabulated.RESULTS The proportion of noneorgan-confined disease was numerically higher in irradiated than in nonirradiated patients (18 of 37 [49%] vs 117 of 327 [36%] patients, P = .1). The difference in the proportion of T4 disease between the 2 groups was statistically significant (13 of 37 [35%] irradiated vs 37 of 327 [11%] nonirradiated patients, P = .005). Pelvic lymph node dissection could not be performed in 7 of 37 irradiated patients. A nonurothelial carcinoma histology was more frequent in irradiated than in nonirradiated patients (5 of 37 [14%] vs 19 of 327 [6%], P = .003). At 3 years, BCa recurrence-free survival estimates were 70 +/- 9% and 77 +/- 3% (log-rank P = .5), and BCa-specific survival estimates were 64 +/- 9% and 69 +/- 3% (log-rank P = .4), for irradiated and nonirradiated patients, respectively. In multivariate analysis, a history of pelvic irradiation was not predictive of BCa recurrence or BCa-specific death. Rates of diversion-related complications did not differ between the 2 groups.CONCLUSION BCa patients with a history of pelvic irradiation present with more advanced disease. Surgery remains difficult in this group of patients as pelvic lymph node dissection is omitted in approximately 1 of 5 patients. Within limitations, prior pelvic irradiation is not predictive of survival outcomes. (C) 2015 Elsevier Inc.