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

doi:10.19558/j.cnki.10-1020/r.2021.06.012

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (987 KB) RICH HTML
输出: BibTeX | EndNote (RIS)

摘要 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_2-4aN_0-1M₀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。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	张勇杰
	李新涛
	赵旭鹏
	董金凯
	李学超
	付成伟
	麦海星
	陈立军

关键词 ：肌层浸润性, 膀胱癌, 新辅助化疗, 围手术期, 预后

Abstract：Objective： To investigate the oncologic and robotic-assisted operative effect of neoadjuvant chemotherapy （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 between 2010 and 2019. The patients with MIBC of clinical stage T_2-4aN_0-1M₀ 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 according 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 revealed 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 complication 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.

Key words： Muscle-invasive Bladder cancer Neoadjuvant chemotherapy Perioperation Prognosis

收稿日期: 2021-10-08

通讯作者: 陈立军,chenlj829@163.com

引用本文:

张勇杰, 李新涛, 赵旭鹏, 董金凯, 李学超, 付成伟, 麦海星, 陈立军. 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[J]. 微创泌尿外科杂志, 2021, 10(6): 411-417.
ZHANG Yongjie, LI Xintao, ZHAO Xupeng, Dong Jinka, LI Xuechao, FU Chengwe, MAI Haixing, CHEN Lijun. Neoadjuvant chemotherapy for muscle-invasive bladder cancer in oncologic and robotic-assisted operative outcomes. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2021, 10(6): 411-417.

链接本文:

http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1725.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2021/V10/I6/411

[1] LIN HY, YE H, KERNEN KM, et al.National cancer database comparison of radical cystectomy vs chemoradiotherapy for muscle-invasive bladder cancer: implications of using clinical vs pathologic staging. Cancer Med, 2018,7(11):5370-5381.
[2] APOLO AB, KIM JW, BOCHNER BH, et al.Examining the management of muscle-invasive bladder cancer by medical oncologists in the United States. Urol Oncol, 2014,32(5):637-644.
[3] HAYNES SR, LAWLERPG. An assessment of the consistency of ASA physical status classification allocation. Anaesthesia, 1995,50(3):195-199.
[4] HUMPHREY PA, MOCH H, CUBILLA AL, et al.The 2016 WHO classification of tumours of the urinary system and male genital Organs-Part B: prostate and bladder tumours. Eur Urol, 2016,70(1):106-119.
[5] DINDO D, DEMARTINES N, CLAVIEN PA.Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004,240(2):205-213.
[6] ZARGAR H, SHAH JB, VAN RHIJN BW, et al.Neoadjuvant dose dense MVAC versus gemcitabine and cisplatin in patients with cT3-4aN0M0 bladder cancer treated with radical cystectomy. J Urol, 2018,199(6):1453-1459.
[7] SUNG H, FERLAY J, SIEGEL RL, et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021,71(3):209-249.
[8] JIANG DM, JIANG H, CHUNG P, et al.Neoadjuvant chemotherapy before bladder-sparing chemoradiotherapy in patients with nonmetastatic muscle-invasive bladder cancer. Clin Genitourin Cancer, 2019,17(1):38-45.
[9] 何天基,葛波.肌层浸润性膀胱癌新辅助治疗现状及展望.临床泌尿外科杂志,2020,35(2):158-161.
[10] WITJES JA, COMPÉRAT E, COWAN NC, et al.EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol, 2014,65(4):778-792.
[11] YIN M, JOSHI M, MEIJER RP, et al.Neoadjuvant chemotherapy for muscle-invasive bladder cancer: a systematic review and Two-Step Meta-Analysis. Oncologist, 2016,21(6):708-715.
[12] INTERNATIONAL COLLABORATION OF TRIALISTS, MEDICAL RESEARCH COUNCIL ADVANCED BLADDER CANCER WORKING PARTY (NOW THE NATIONAL CANCER RESEARCH INSTITUTE BLADDER CANCER CLINICAL STUDIES GROUP), EUROPEAN ORGANISATION FOR RESEARCH AND TREATMENT OF CANCER GENITO-URINARY TRACT CANCER GROUP, MEDICAL RESEARCH COUNCIL ADVANCED BLADDER CANCER WORKING PARTY (NOW THE NATIONAL CANCER RESEARCH INSTITUTE BLADDER CANCER CLINICAL STUDIES GROUP), EUROPEAN ORGANISATION FOR RESEARCH AND TREATMENT OF CANCER GENITO-URINARY TRACT CANCER GROUP, et al. International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA06 30894 trial. J Clin Oncol, 2011,29(16):2171-2177.
[13] 温力. 吉西他滨联合顺铂新辅助化疗对膀胱癌根治术患者预后的影响.实用癌症杂志,2016,31(9):1498-1500.
[14] 龚华,沈兵,谈明岳,等.顺铂为主的新辅助化疗方案治疗进展性膀胱癌的疗效分析.临床和实验医学杂志,2011,10(10):749-751.
[15] RAI BP, BONDAD J, VASDEV N, et al. Robotic versus open radical cystectomy for bladder cancer in adults. Cochrane Database Syst Rev, 2019(4)：CD011903.
[16] 王莉萍,王帅,祁小龙,等.机器人辅助与普通腹腔镜根治性膀胱切除术+原位回肠新膀胱术后性功能的对比研究.中华泌尿外科杂志,2020,41(5):356-361.