Outcome of patients with bladder cancer with pN+ disease after preoperative chemotherapy and radical cystectomy.
Outcome of patients with bladder cancer with pN+ disease after preoperative chemotherapy and radical cystectomy.
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DOI：
10.1016/j.urology.2008.07.035
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发表时间：
2009-01
期刊：
影响因子：
2.1
通讯作者：
Kamat, Ashish M.
中科院分区：
文献类型：
--
作者：
Kassouf, Wassim;Agarwal, Plyush K.;Grossman, H. Barton;Lelbovici, Dan;Munsell, Mark F.;Slefker-Radtke, Arlene;Pisters, Louis L.;Swanson, David A.;Dinney, Colin P. N.;Kamat, Ashish M.
尿路上皮癌(UC)术前化疗后手术标本中的持续性结节病变(PN+)与预后不良有关。为了提高我们对这类患者预后的了解，我们对我们的经验进行了回顾。1993-2003年间，857例膀胱癌患者接受了根治性膀胱切除术，其中150例为PN+。在这些患者中，尽管术前接受了化疗，但仍有37人PN+，这构成了本报告的基础。生存资料采用Kaplan-Meier法和Cox回归分析。患者的中位年龄为66岁(39~85岁)，中位随访时间为50个月(13.0~58.7个月)。临床分期(术前化疗开始时)：ct2伴淋巴管侵犯7例，cT3b：6例，cT4a：4例，cT4b：2例，CN+18例。2年总生存率(OS)为20%，疾病特异性生存率(DSS)为29.2%，无复发生存率(RFS)为13.5%。11名患者(30%)术后接受了辅助化疗；大多数患者(73%)是以铂为基础的方案。在多变量分析中，手术切缘状况、性别和组织学与OS显著相关，组织学和辅助化疗的使用与RFS显著相关。尽管术前化疗，但仍有持续性结节病变的患者预后较差。一群这样的患者可能会在辅助化疗方面做得很好。术前化疗后有淋巴结转移的患者，淋巴结密度和PT分期不能预测预后。
Persistent nodal disease in the surgical specimen (pN+) after preoperative chemotherapy for urothelial carcinoma (UC) is associated with poor prognosis. To improve our understanding regarding outcome of such patients, we performed a retrospective review of our experience. Between 1993–2003, 857 patients underwent radical cystectomy for UC of the bladder, and 150 were found to be pN+. Of these, 37 were pN+ despite preoperative chemotherapy and form the basis of this report. Survival data were analyzed using Kaplan-Meier method and Cox regression analysis. The patients’ median age was 66 years (range 39 to 85 years), and the median follow-up was 50 months (range 13.0 to 58.7 months). Clinical stages (at time of initiation of preoperative chemotherapy) were cT2 with lymphovascular invasion: 7, cT3b: 6, cT4a: 4, cT4b: 2, and cN+: 18. The 2-year overall (OS), disease-specific (DSS), and recurrence-free (RFS) survival rates were 20%, 29.2%, and 13.5%, respectively. Eleven (30%) patients received adjuvant chemotherapy after surgery; majority (73%) were platinum-based regimens. On multivariate analysis, surgical margin status, gender, and histology were significantly associated with OS, and histology and use of adjuvant chemotherapy were significantly associated with RFS. Patients who have persistent nodal disease despite preoperative chemotherapy have a poor prognosis. A cohort of such patients may do well with adjuvant chemotherapy. Lymph node density and pT stage are not prognostic in patients with nodal metastasis after preoperative chemotherapy.
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影响因子：
158.5
作者：
Grossman, HB;Natale, RB;Crawford, ED
通讯作者：
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