比較肌肉侵犯性膀胱癌經三重療法達完全有效與前導性化學治療併膀胱全切除治療結果之經驗報告
李瑋涓1、張議徽1、張兆祥1、楊啟瑞1、黃志平1, 2、葉進仲1、鄒頡龍1,2、陳汶吉1,3、謝博帆1,2、吳錫金2, 4
中國醫藥大學附設醫院 1泌尿部；2中國醫藥大學 醫學系 泌尿學科；3中國醫藥大學 中醫學院中西醫結合研究所；4中國醫藥大學附設醫院北港分院 泌尿部
Comparison between Complete response of trimodality therapy and neoadjuvant chemotherapy with radical cystectomy in muscle invasive bladder cancer - CMUH experience
Wei-Juan Li1, Yi-Huei Chang1, Chao-Hsiang Chang1,Chi-Rei Yang1, Chi-Ping Huang1,2, Chin-Chung Yeh1, Chieh-Lung Chou1,2, Wen-Chi Chen1,3, Po-Fan Hsieh1,2, Hsi-Chin Wu2,4
1Department of Urology, China Medical University Hospital, Taichung, Taiwan
2School of Medicine, China Medical University, Taichung, Taiwan
3Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
4Department of Urology, China Medical University Beigang Hospital, Beigang, Yunlin, Taiwan
Purpose:
Radical cystectomy was gold standard for muscle-invasive bladder cancer. However, trimodality therapy (TMT) consisting of maximal transurethral resection of the bladder tumor followed by concurrent chemotherapy and radiation developed with promising outcomes. The study aim to compare the outcome of neoadjuvant with radical cystectomy (NAC+RC) and complete response after trimodality therapy.
Materials and Methods:
Between 2008 and 2018, retrospectively, thirteen patients received trimodality therapy and seven patients reached complete response after trimodality therapy. Thirteen patients received neoadjuvant chemotherapy and following radical cystectomy with postoperative pathology staging T0N0. Demographic, perioperative data and postoperative outcomes were collected and statistically analyzed.
Results:
There were no significant difference of gender, ECOG, initial presentation, clinical staging between the two groups except age and comorbidities. The mean age of TMT group was older than NAC+RC group (69 vs. 60 years, p=0.03) and the mean Charlson Comorbidity Index (CCI) of TMT group was higher than NAC+RC group (6 vs. 3 score, p=0.02). The recurrence rate of TMT group was 42.3% and NAC+RC groups was 7% (p<0.01). The progression-free survival (PFS) and overall survival (OS) was 36.7 months and 38.8 months in TMT group while in NAC+RC group, PFS was 61.9 months and OS was 62.4 months. The 3-year PFS and 3-year OS was both 42.9% in TMT group and 76.9% and 84.6% in NAC+RC group (p<0.01).
Conclusion:
The study showed the significant benefit of neoadjuvant chemotherapy with radical cystectomy comparing to trimodality therapy. The possible causes might be the older age and more comorbidities in trimodality therapy patients.