局部肌肉侵犯性膀胱癌新輔助性化療後膀胱部份切除治療

-楊啟瑞,

中國醫藥大學附設醫院泌尿部

Partial Cystectomy after Neoadjuvant Chemotherapy for Muscle Invasive Bladder Cancer

Chi-rei Yang

Purpose:

To report of personal acuminated experience with partial cystectomy after neoadjuvant chemotherapy.

Patients and Methods:

Retrospective review of patients who underwent neoadjuvant chemotherapy and partial cystectomy for muscle invasive c urothelial cell carcinoma of the bladder at CMUH and TCVGH from 1993 to 2019. All patients received standard TURBT with deep cut muscle biopsy for staging (15 cT2a, 3T2b and T3b). Tumor locate at dome in 7 patients and lateral wall in 13 patients. Three of them had adjacent cis. All underwent 2to 3 cycles of neoadjuvant chemotherapy (9 MEC, 10 GC and one G+Carbo plus IO). Following repeated TURBT restaging to T0, T1 and T2. All patients underwent bilateral pelvic node dissection and partial cystectomy with at least one cm margin. Following surgery all patients were follow up periodic cystoscopy and CT scan. Log-rank test was used to analyze variables possibility associated with recurrence-free and overall survival rate.

Results:

Following partial cystectomy, 15 patients remained pT0, 3pT1, one pT2 and one had residual cis. Two patients have positive node (one pT0N1 and another pT2N1). After 2 to 20 years follow up 7 had local recurrences. 4 patients staged cT1 disease was controlled by repeated TURBT and BCG. Another 3 patients with disease progress to cT2 and Two underwent salvage radical cystectomy and another controlled by repeated partial cystectomy. Three had upper tract recurrence and salvage nephroureterectomy of 15 patients follow up more than 5 years, recurrent free survival was 67 percent and overall survival was 83 percent.

Conclusions:

Partial cystectomy following neoadjuvant chemotherapy is a reasonable option for organ preserving in patients with solitary muscle invasive bladder cancer arising from suitable location.