肌肉侵襲性膀胱癌接受前導性化療預後的預測因子

蕭博任1、張議徽1、陳冠亨1、葉進仲1、陳汶吉1、黃志平1、吳錫金2、楊啟瑞1、張兆祥1、林精湛3

1中國醫藥大學附設醫院 泌尿部

2中國醫藥大學北港附設醫院 泌尿部

3中國醫藥大學附設醫院 血液腫瘤科

Predictive markers for the prognosis of muscle invasive bladder cancer treated with neoadjuvant chemotherapy

Po-Jen Hsiao1, Yi-Huei Chang1, Guang-Heng Chen1, Chin-Chung Yeh1, Wen-Chi Chen1, Chi-Ping Huang1, Hsi-Chin Wu2, Chi-Rei Yang, Chao-Hsiang Chang1, Ching-Chan Lin3

1Department of Urology, China Medical University Hospital, Taichung, Taiwan

2Department of Urology, China Medical University Beigang Hospital, Beigang, Taiwan

3Department of Hematology and Oncology, China Medical University Hospital, Taichung, Taiwan

Purpose: We want to investigate the predictors of the effect neoadjuvant chemotherapy in muscle invasive bladder cancer in Taiwan.

Materials and Methods: This is a retrospective study. Sixty-eight patients undergone neoadjuvant chemotherapy for muscle invasive bladder urothelial carcinoma in August, 2008 to August April, 2016. Neoadjuvant chemotherapy regiment is Gemcitabine plus Cisplatin or Carboplatin according to renal function of patient. All patients received radical cystectomy and bilateral pelvic lymph node dissection. Demographic and disease characteristics as predictive markers were collected from the medical records retrospectively.

Results: 85.3% of patients received NC were cT3-T4 or clinical nodal disease. The mean age of the patients was 64.37 years old. Pathologic complete responses (pT0) were achieved in 13.2% patients. Any pathologic response (≤pT1) was seen in 20.5% and 25% of G/Cis and G/Carbo patients, respectively. Low clinical stage, complete response and any pathological response showed benefit to overall and recurrence free survival. Histology differentiation, lymphovascular invasion and perineural invasion in specimen was related to chemotherapy response (P=0.003) and overall survival. The duration after chemotherapy to operation seemed no significant related to prognosis. The neutrophil to lymphocyte ratio (NLR=2.26) before neoadjuvant chemotherapy had a trend to predict better overall survival and recurrence free survival.

Conclusions:

The utilization rate of neoadjuvant chemotherapy in our center was 45.3%. Some predictors such as clinical stage, response of chemotherapy, histopathology of cancer, and NLR may help distinguishing individuals more likely to benefit from neoadjuvant chemotherapy upfront cystectomy.

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    台灣泌尿科醫學會
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    2017-06-01 11:24:20
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    2017-06-01 11:36:17
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