Surgical factors influence bladder cancer outcomes: A cooperative group report
Surgical factors influence bladder cancer outcomes: A cooperative group report
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DOI：
10.1200/jco.2004.11.024
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发表时间：
2004-07-15
影响因子：
45.3
通讯作者：
Crawford, ED
中科院分区：
文献类型：
--
作者：
Herr, HW;Faulkner, JR;Crawford, ED
目的 一项随机、合作组试验（西南肿瘤组 8710，组间 0080）报道，新辅助化疗改善了接受根治性膀胱切除术治疗的局部晚期膀胱癌患者的生存率。我们评估了参加该研究的患者的手术因素是否可以预测膀胱癌的结果。患者和方法根据 268 名接受根治性膀胱切除术的肌层浸润性膀胱癌患者的手术和病理报告记录了手术和肿瘤因素。膀胱切除术由 109 个机构的 106 名外科医生进行。一半患者接受新辅助甲氨蝶呤、长春碱、阿霉素和顺铂 (MVAC) 化疗。在单变量和多变量分析中测试变量与所有接受膀胱切除术的患者的膀胱切除术后生存率 (PCS) 和局部复发 (LR) 的关系。结果 五年 PCS 和 LR 率分别为 54% 和 15%。针对 MVAC (P = .97)、年龄 (P = .03)、病理分期 (P = .0002) 和淋巴结状态 (P = .04) 进行调整的多变量模型显示，与较长 PCS 相关的手术变量为负切缘（v 阳性；风险比 [HR]，0.37；P = .0007），并且切除的淋巴结大于或等于 10 个（v < 10；HR， 0.51；P = .0001)。这些关联在治疗组之间没有差异（对于治疗和手术变量之间相互作用的所有测试，P > .21）。调整 MVAC (P = .16)、病理分期 (P = .02) 和淋巴结状态 (P = .37) 的多变量模型中 LR 的预测因素为阳性切缘（v 为阴性；比值比 [OR], 11.2；P = .0001），且切除的淋巴结少于 10 个（v 大于或等于 10；OR，5.1；P = .002）。调整病理因素和新辅助化疗后，影响膀胱癌预后的因素。 (C) 2004 年，美国临床肿瘤学会。
Purpose A randomized, cooperative group trial (Southwest Oncology Group 8710, Intergroup 0080) reported that neoadjuvant chemotherapy improved the survival of patients with locally advanced bladder cancer who were treated with radical cystectomy. We evaluated whether surgical factors from patients enrolled onto the study predicted bladder cancer Outcomes.Patients and Methods Surgical and tumor factors were recorded from surgical and pathologic reports from 268 patients with muscle-invasive bladder cancer who received radical cystectomy. Cystectomies were performed by 106 surgeons in 109 institutions. Half of the patients received neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) chemotherapy. Variables were tested in univariate and multivariate analyses for associations with postcystectomy survival (PCS) and local recurrence (LR) in all patients receiving cystectomy.Results Five-year PCS and LR rates were 54% and 15%, respectively. A multivariate model adjusted for MVAC (P = .97), age (P = .03), pathologic stage (P = .0002), and node status (P = .04) showed that surgical variables associated with longer PCS were negative margins (v positive; hazard ratio [HR], 0.37; P = .0007), and greater than or equal to 10 nodes removed (v < 10; HR, 0.51; P = .0001). These associations did not differ by treatment arms (P > .21 for all tests of interactions between treatment and surgical variables). Predictors of LR in a multivariate model adjusted for MVAC (P = .16), pathologic stage (P = .02), and node status (P = .37) were positive margins (v negative; odds ratio [OR], 11.2; P = .0001) and fewer than 10 nodes removed (v greater than or equal to 10; OR, 5.1; P = .002).Conclusion Surgical factors influence bladder cancer outcomes after cystectomy, after adjustment for pathologic factors and neoadjuvant chemotherapy usage. (C) 2004 by American Society of Clinical Oncology.