比較肌肉侵犯性膀胱癌各期別以膀胱保留三聯療法與根治性膀胱切除術的治療效益
曾文歆1、黃冠華1、劉建良1、邱文祥2
奇美醫學中心 外科部 泌尿外科
Comparison of Trimodal Therapy Versus Radical Cystectomy for Each Stage of Muscle-invasive Bladder Cancer
Wen-Hsin Tseng1、Steven K. Huang1、Chien-Liang Liu1、Allen W.Chiu 5,6
1Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
2Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
Abstract
Purpose
Radical cystectomy (RC) has long been the standard of care for the management of muscle-invasive bladder cancer (MIBC). However, an increasing trend of bladder-sparing trimodal therapy (TMT) using maximal transurethral resection of bladder tumor (TURBT), followed by radiotherapy (RT) with concomitant radiosensitizing chemotherapy, has been advocated. We compared the differences regarding long-term oncological outcomes between patients who accepted RC or TMT for MIBC.
Methods
Between January 2012 and December 2018, 207 patients were diagnosed with MIBC at our center. We excluded patients with metastasis disease, received other treatment, and lost to follow-up. The patients were categorized into Group 1(TMT) and Group 2(RC). Both groups with each tumor stages were compared for disease-free survival (DFS) and overall survival (OS) rates, and the risk factors for recurrence and survival were assessed.
Results
In total, 58 (48.7%) patients in Group 1 underwent TMT, and 61 (51.3%) patients in Group 2 underwent RC. The mean follow-up was 39.8 months. The three-year DFS rates were 44.1% and 69.7% for Groups 1 and 2 respectively (p=0.003). The three-year OS rates were 61.7% and 72.5% for Groups 1 and 2 respectively (p=0.226). We also analyzed the DFS with each stage and the results showed a lower DFS rate for T2 and N0 stages.
Conclusion
There was no significant survival benefit for MIBC with either RC or TMT. However, RC is associated with better outcome of DFS rate, especially for patients with early stages of MIBC in stage T2 and N0.