ABSTRACT
Purpose@#Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy. @*Materials and Methods@#Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate. @*Results@#Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory. @*Conclusion@#After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.
ABSTRACT
Bladder cancer is one of the tenth most common malignant tumors in Chinese men.Almost 20％ to 30％ patients are diagnosed as the muscle-invasive bladder cancer (MIBC) at the first diagnosis.In the past,radical cystectomy (RC) was the first-line treatment with MIBC.The current researches'results show that,neoadjuvant chemotherapy combined with RC can improve the tumor complete response rate and prolong the overall survival of patients with MIBC,comparing with the RC alone.It has become the recommended standard first line treatment for MIBC,which has the possiblity of preserving bladder.Lots of researches indicate that the application of cisplatin-based neoadjuvant chemotherapy in patients with MIBC is becoming more and more popular.However,there is still the possibility of ineffectiveness or tumor progression.Therefore,discussions about the sensitivity of neoadjuvant chemotherapy have always been a hot spot in urological tumor research.In order to provide guidance and help for clinical work,the article reviews the sensitivity of neoadjuvant chemotherapy of bladder urothelial carcinoma.
ABSTRACT
Bladder cancer is one of the tenth most common malignant tumors in Chinese men. Almost 20% to 30% patients are diagnosed as the muscle-invasive bladder cancer (MIBC) at the first diagnosis.In the past, radical cystectomy (RC) was the first-line treatment with MIBC.The current researches' results show that, neoadjuvant chemotherapy combined with RC can improve the tumor complete response rate and prolong the overall survival of patients with MIBC, comparing with the RC alone. It has become the recommended standard first line treatment for MIBC, which has the possiblity of preserving bladder. Lots of researches indicate that the application of cisplatin-based neoadjuvant chemotherapy in patients with MIBC is becoming more and more popular. However, there is still the possibility of ineffectiveness or tumor progression. Therefore, discussions about the sensitivity of neoadjuvant chemotherapy have always been a hot spot in urological tumor research. In order to provide guidance and help for clinical work, the article reviews the sensitivity of neoadjuvant chemotherapy of bladder urothelial carcinoma.