J Urol:膀胱切除术前新辅助化疗对肌肉浸润性膀胱癌的病理分期和生存预后的益处

2021-05-28 Nebula MedSci原创

新辅助化疗与所有组织学变异类型的肌肉浸润性膀胱癌的病理分期下调相关,还多种组织亚型的患者的OS改善相关

膀胱癌是男性第4常见的癌症,在所有人群中的发病率排名第6,占全部癌症病例的4.4%。组织学变异的肌肉浸润性膀胱癌 (MIBC) 患者的预后较差。目前尚不清楚根治性膀胱切除术前新辅助化疗是否与组织学变异患者的病理分期下降或总生存期 (OS) 改善有关。

本研究旨在评估组织学变异MIBC患者接受新辅助化疗与病理分期下降和OS之间的关联。

研究人员从国家癌症数据库中筛查了2004年-2017年接受根治性膀胱切除术的无转移的MIBC患者。按组织学亚组、有无接受新辅助化疗进行分层。病理分期下降定义为pT0N0或pT≤1N0,OS位从确诊到死亡或最后随访的时间。采用多变量逻辑回归分析新辅助化疗与病理分期下降之间的关联。采用多变量Cox回归分析确定新辅助化疗与OS之间的关联。

最终研究人群 纳入了31218例患者:尿路上皮癌(UC): 27779例; 肉瘤样UC: 501例; 微乳头状UC: 418例; 鳞状细胞癌(SCC): 1141例; 神经内分泌癌: 629例; 腺癌: 750例。

有无新辅助化疗的患者的病理分期下调情况

在所有组织学亚组中,新辅助化疗与病理分期下调至pT0N0相关(UC的优势比[OR]:5.1[95%CI 4.6-5.6]; 肉瘤样UC:13.8 [5.5-39.0]; 微乳头状UC:9.7 [2.8-46.8]; SCC:7.4 [2.1-24.5]; 神经内分泌:4.7 [2.6-9.2]; 腺癌:23.3 [8.0-74.2])。

新辅助化疗与UC (HR 0.8 [0.77-0.84])、肉瘤样UC (HR 0.64 [0.44-0.91]) 和神经内分泌癌 (HR 0.55 [0.43-0.70]) 患者的OS改善相关。

总之,新辅助化疗与所有组织学变异类型的MIBC的病理分期下调相关,还与UC、肉瘤样UC和神经内分泌癌患者的OS改善相关

原始出处:

Chakiryan Nicholas H,Jiang Da David,Gillis Kyle A et al. Pathologic Downstaging and Survival Outcomes Associated with Neoadjuvant Chemotherapy for Variant Histology Muscle Invasive Bladder Cancer. J Urol, 2021, undefined: 101097JU0000000000001855.

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    2021-05-29 yelinlin

    积极评论

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1877430, encodeId=8ecf18e743073, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Sun Jun 06 10:52:30 CST 2021, time=2021-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1678676, encodeId=eda816e867676, content=<a href='/topic/show?id=110c5869153' target=_blank style='color:#2F92EE;'>#新辅助#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58691, encryptionId=110c5869153, topicName=新辅助)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=941f27706894, createdName=charl1234576, createdTime=Sat Jun 05 06:52:30 CST 2021, time=2021-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2041295, encodeId=ba612041295b1, content=<a href='/topic/show?id=2f826902418' target=_blank style='color:#2F92EE;'>#生存预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69024, encryptionId=2f826902418, topicName=生存预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Tue Mar 08 01:52:30 CST 2022, time=2022-03-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1953664, encodeId=37a3195366484, content=<a href='/topic/show?id=ef23e10126d' target=_blank style='color:#2F92EE;'>#病理分期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71012, encryptionId=ef23e10126d, topicName=病理分期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25c8396, createdName=ssnine, createdTime=Mon Dec 06 01:52:30 CST 2021, time=2021-12-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493847, encodeId=86cd149384e97, content=<a href='/topic/show?id=238d85e749c' target=_blank style='color:#2F92EE;'>#膀胱切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85774, encryptionId=238d85e749c, topicName=膀胱切除术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e77d9117128, createdName=tonychen24, createdTime=Sun May 30 13:52:30 CST 2021, time=2021-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=969386, encodeId=5f5b96938634, content=积极评论, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK0iclWFtP7WicKXLyVXAOnRibMria0BwB4otV2d2ibbbkZ2XKAvnNH5x3Y1wm9ibMNZZV5ib5qA0B99sMpw/132, createdBy=9a062530214, createdName=yelinlin, createdTime=Sat May 29 09:49:37 CST 2021, time=2021-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1040031, encodeId=160f1040031c6, content=膀胱癌真怪,明明是免疫敏感性肿瘤,为什么PD-1治疗效果不好呢?难道靶点不对?将来CD47会不会有效, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=留走人康, createdTime=Sat May 29 01:52:30 CST 2021, time=2021-05-29, status=1, ipAttribution=)]
    2021-05-29 留走人康

    膀胱癌真怪,明明是免疫敏感性肿瘤,为什么PD-1治疗效果不好呢?难道靶点不对?将来CD47会不会有效

    0

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部分代谢反应根据SULpeak反应(-50%)进一步分类而改良的PERCIST可能比PERCIST1.0更适合用于评估肿瘤反应,并对复发和预后不良的高危患者进行分层

J Immunother Cancer:肿瘤浸润免疫细胞的动态变化可预测患者对新辅助化疗的反应

早期免疫细胞浸润动力学的全面分析补充了pCR的预测标志物,有望改善TNBC患者的个性化治疗策略的调整