辅助化学疗法对pT3期膀胱移行细胞癌患者行根治性膀胱切除术后生存率的影响

Impact of adjuvant chemotherapy on survival of patients with pT3 bladder urothelial carcinoma after radical cystectomy

目的探讨在行根治性膀胱切除术(radical cystectomy,RC)后的p T3期膀胱移行细胞癌(urothelial carcinoma of the bladder,UCB)患者中,辅助化学疗法(化疗)对生存率的影响。方法回顾性分析2005年1月—2010年6月间行RC的223例UCB患者治疗和随访资料,所有患者均未接受新辅助化疗,其中75例(33.6%)诊断为p T3期(包括32例p T3a期和43例p T3b期)。随访资料截至2015年6月。应用Kaplan-Meier法计算生存率,对数秩检验比较生存曲线,采用Cox比例风险模型进行多因素分析。结果吉西他滨和顺铂方案辅助治疗p T3期UCB近期疗效的总有效率为60.0%。p T3a期和p T3b期患者具有相似的5年总生存率(47.9%、43.3%,P=0.682)和癌特异生存率(57.4%、57.6%,P=0.796)。在p T3期患者中,辅助化疗对于总生存期(P=0.032)是一个独立的预测因子。p T3亚分期的多变量分析中,辅助化疗仅在p T3b期群体中对总生存期[风险比(hazard ratio,HR)=0.37,95%置信区间(confidence interval,CI)(0.15,0.68),P=0.006]和癌特异生存期[HR=0.34,95%CI(0.12,0.86),P=0.022]有显著改善。结论由于p T3b期宏观膀胱周组织入侵的特点,辅助化疗可能改善患者总生存期。

Objective To assess the impact of adjuvant chemotherapy （ACH） on the survival of patients with pT3 urothelial carcinoma of the bladder （UCB） after radical cystectomy （RC）. Methods We retrospectively analyzed the clinical and follow-up data of 223 UCB patients who underwent RC between January 2005 and June 2015. None of the patients received neoadjuvant chemotherapy. Of all the patients, 75 （33.6%） were diagnosed as pT3 cancer （including 32 pT3a and 43 pT3b patients）. The follow-up data were up to June 2015. Kaplan-Meier method with log-rank test was used to estimate and compare overall survival （OS） and cancer-specific survival （CSS） between groups. Multivariate Cox proportional hazard models were used to identify predictors of OS and CSS. Results The short-term total effective rate of gemcitabine and cisplatin assisted chemotherapy in the treatment of pT3 UCB was 60.0%. Five-year OS rate （47.9%vs. 43.3%） and CSS rate （57.4%vs. 57.6%） were similar in the pT3a and pT3b groups （P=0.682 and 0.796, respectively）. In pT3 patients, adjuvant chemotherapy was an independent predictor for OS （P=0.032）. On multivariate analysis, according to the pT3 sub-stage, ACH was significantly associated with improved OS [hazard ratio （HR） =0.37; 95% confidence interval （CI） （0.15, 0.68）,P=0.006] and CSS [HR=0.34, 95%CI （0.12, 0.86）,P=0.022] in the pT3b group only. Conclusion Because pT3b cancer is characterized by macroscopic peri-vesical tissue invasion, patients may obtain an OS benefit from the administration of adjuvant chemotherapy.