預測肌肉侵襲型膀胱癌使用先導型化學治療的病理反應

徐震翰¹、林子平^1,2、林登龍^1,2、張延驊^1,2、鍾孝仁^1,2、黃逸修^1,2、

林志杰^1,2、黃奕燊^1,2、黃子豪^1,2、陳威任^1,2、黃志賢^1,2

台北榮民總醫院泌尿部¹ ； 國立陽明交通大學醫學院泌尿學科及書田泌尿科學研究中心²

Predictors of pathologic response to neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer

Chen-Han Hsu¹, Tzu-Ping Lin^1,2, Alex T.L. Lin^1,2, Yen-Hwa Chang^1,2, Hsiao-Jen Chung^1,2, Eric Yi-Hsiu Huang^1,2, Chih-Chieh Lin^1,2, I-shen Huang^1,2, Tzu-Hao Huang^1,2, Wei-Jen Chen^1,2, William J.S. Huang^1,2

Department of Urology, Taipei Veterans General Hospital¹,

Department of Urology, School of Medicine and Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University², Taipei, Taiwan

Purpose:

Standard treatment for patients with localized muscle-invasive bladder cancer (MIBC) is neoadjuvant chemotherapy (NAC) and radical cystectomy (RC). While pathologic response is associated with long-term survival in patients with MIBC, it is hard to predict which patients will benefit from NAC. Thus, we aim to identify factors that could predict pathologic response to NAC therapy in patients with MIBC.

Materials and Methods:

Between March 2013 and March 2023, we conducted a retrospective study in 58 patients with localized MIBC who received NAC and RC. We collected data on the NAC regimen, histological features, pathologic complete response (pCR), defined as ypT0N0, and pathologic downstaging, defined as <ypT2N0. Histological features were divided into papillary urothelial carcinoma (UC) and non-papillary UC group, while NAC regimens were further divided into Cisplatin-based and Carboplatin-based groups. Associations between pathologic response and clinicopathological characteristics were assessed with Fisher’s exact test or Chi-square test.

Results:

Among 58 patients, 43 (74.1%) were male, and 15 (25.9%) were female, with a mean age of 64.34 years (range 35-86 years). For histological features, 15(25.9%) had papillary UC, while 43 (74.1%) had non-papillary UC. Pathologic complete response was achieved in 6 patients (40.0%) in the papillary UC group, and 9 patients (20.9%) in the non-papillary UC group. Pathologic downstaging was achieved in 9 patients (60.0%) in the papillary UC group, and 13 patients (30.2%) in the non-papillary UC group. Only pathologic downstaging reached statistical difference (P=0.041) between different histological groups. For NAC regimens, 52(89.7%) were Cisplatin-based group, while 6 (10.3%) were Carboplatin-based group. Pathologic complete response was achieved in 14 patients (26.9%) in the Cisplatin-based group, and 1 patient (16.7%) in the Carboplatin-based group. Pathologic downstaging was achieved in 21 patients (40.4%) in the Cisplatin-based group, and 1 patient (16.7%) in the Carboplatin-based group. No statistical difference was found between the two different NAC regimen groups.

Conclusions:

In our study, histological features of papillary UC may be predictors of pathologic response to NAC in patients with MIBC, while NAC regimens did not show significant differences.