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.