新辅助化疗对肌层浸润性膀胱癌的肿瘤学效果及机器人手术的影响

Neoadjuvant chemotherapy for muscle-invasive bladder cancer in oncologic and robotic-assisted operative outcomes

目的:研究新辅助化疗(NAC)对肌层浸润性膀胱癌(MIBC)的肿瘤学效果及机器人手术的影响。方法:收集2010-2019年在中国人民解放军总医院泌尿外科医学部确诊的年龄在18~80岁临床分期为T_(2-4a)N_(0-1)M_(0)期的MIBC患者进行研究,手术方式均为机器人辅助根治性膀胱切除术(RARC)+盆腔淋巴结清扫术(PLND),尿道改道方式为回肠膀胱术(Bricker术式),按术前是否使用4个疗程吉西他滨+顺铂(GC)的新辅助化疗方案将患者分为NAC组与对照组。采用倾向性评分匹配(PSM)、Chi-square检验、Kruskal-Wallis检验、多元回归分析等对两组患者的临床资料进行分析。结果:入组患者均符合纳排标准,NAC组与对照组按PSM的1:2匹配,共有30例患者完整使用4个疗程GC方案联合RARC+PLND,60例患者未行GC方案直接接受RARC+PLND治疗。多元回归分析提示,新辅助GC方案是行RARC+PLND的MIBC患者预后的独立保护因素(HR=0.35,95%CI=0.1~1.0,P=0.042)。结论:新辅助GC方案不增加行RARC+PLND的MIBC患者的围手术期相关风险,对于接受RARC+PLND治疗的MIBC患者是一种更优的治疗决策,值得推广。

Objective:To investigate the oncologic and robotic-assisted operative effect of neoadjuvant chemo‐therapy(NAC)on muscle-invasive bladder cancer(MIBC).Methods:In the Senior Urology Department of PLA General Hospital,we assembled the records of patients with MIBC over 18 and under 80 years of age diagnosed be‐tween 2010 and 2019.The patients with MIBC of clinical stage T_(2-4a)N_(0-1)M_(0)were enrolled in this study,and accepted the treatments of robotic-assisted radical cystectomy(RARC)+pelvic lymph node dissection(PLND).The ileal conduit(Bricker)was used for urinary diversion.The patients were divided into NAC group and control group accord‐ing to whether the patients received 4 cycles of gemcitabine and cisplatin(GC)before operation.Propensity-score matching(PSM),Chi-square test,Kruskal-Wallis test and multivariate regression analysis were used to analyze the clinical data.Results:A total of 30 patients with NAC+RARC+PLND were enrolled and 60 patients receiving RARC+PLND without NAC served as control group according to PSM 1∶2.The multiple regression analysis re‐vealed neoadjuvant GC was an independent prognostic factor for undergoing RARC+PLND(HR=0.35,95%CI=0.1-1.0,P=0.042)in MIBC patients.Conclusion:The NAC can’t increase rate of postoperative complica‐tion in the MIBC patients who were treated with RARC+PLND,and the neoadjuvant GC was a better treatment in locally advanced MIBC patients compared with operation alone.The application of neoadjuvant chemotherapy is worth recommending.