Node-Positive Bladder Cancer After Neoadjuvant Chemotherapy Followed by Radical Cystectomy: A Single-Center Retrospective Study
조장호, 권기영, 강민용, 성현환, 전황균, 정병창, 서성일, 전성수, 이현무, 최한용, 이수진, 박세훈,
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조장호 ( Cho Jang-Ho )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
권기영 ( Kwon Ghee-Young )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pathology
강민용 ( Kang Min-Yong )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
성현환 ( Sung Hyun-Hwan )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
전황균 ( Jeon Hwang-Gyun )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
정병창 ( Jeong Byong-Chang )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
서성일 ( Seo Seong-Il )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
전성수 ( Jeon Seong-Soo )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
이현무 ( Lee Hyun-Moo )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
최한용 ( Choi Han-Yong )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Urology
이수진 ( Lee Su-Jin )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
박세훈 ( Park Se-Hoon )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
Abstract
Purpose: There remains a lot of unmet need to increase understanding of node-positive (ypN+) muscle invasive bladder cancer (MIBC) after neoadjuvant chemotherapy and radical cystectomy to decide the appropriate therapeutics.
Materials and Methods: In a retrospective study using the center cancer chemotherapy registry, we found 113 MIBC patients who were treated with neoadjuvant chemotherapy involving gemcitabine and cisplatin (GP) followed by radical cystectomy between 2010 and 2014. Disease-free survival (DFS) and overall survival (OS) were compared according to the pathologic node positivity (ypN- vs. ypN+). Among a total of 165 patients with MIBC who received neoadjuvant chemotherapy involving GP, 118 underwent radical cystectomy. In 46 patients with ypN+ disease, DFS and OS were evaluated according to administration of adjuvant GP.
Results: After neoadjuvant chemotherapy and radical cystectomy, 41% of patients had ypN+ disease, which showed significantly shorter DFS (median, 7.4 months; 95% confidence interval [CI], 5.3?9.6 months) and OS (median, 20.0 months; 95% CI, 13.4?26.6 months) compared to those with ypN- disease. The patients with ypN+ disease had a high risk of recurrence or death, regardless of the administration of adjuvant chemotherapy or adjuvant regimen.
Conclusions: Within the limitations of this retrospective study, MIBC patients with ypN+ disease despite neoadjuvant chemotherapy and radical cystectomy had a poor prognosis. Further studies involving novel, effective adjuvant treatment including immunotherapy agents are needed to reduce the high risk of recurrence or death in these patients.
키워드
Urinary bladder neoplasms; Neoadjuvant chemotherapy; Lymph nodes; Cystectomy
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