膀胱切除术
医学
膀胱癌
肿瘤科
内科学
吉西他滨
淋巴血管侵犯
长春碱
新辅助治疗
化疗
泌尿科
癌症
转移
乳腺癌
作者
Stéphane Culine,Valentin Harter,Clémentine Krucker,G. Gravis,Aude Flechon,Christine Chevreau,Hakim Mahammedi,Brigitte Laguerre,Aline Guillot,Florence Joly,Jacqueline Fontugne,Yves Allory,Christian Pfister
出处
期刊:Cancers
[MDPI AG]
日期:2023-03-13
卷期号:15 (6): 1742-1742
标识
DOI:10.3390/cancers15061742
摘要
Neoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy and pelvic lymph node dissection is the optimal treatment for patients with muscle-invasive bladder cancer. In recent years, the VESPER trial showed a statistically significant higher progression-free survival with dd-MVAC (dose dense methotrexate, vinblastine, doxorubicin, and cisplatin) compared to GC (gemcitabine and cisplatin). In the present report, we refine the characterization and outcome of patients whose cystectomy specimens were pathologically free of cancer (pathological complete response, pCR). We confirm that these patients portend a better outcome as compared to patients with invasive disease (≥pT1N0) at cystectomy. Nested variant and lymphovascular invasion were identified as adverse predictive factors of pCR. Progression-free survival probability three years after pCR on cystectomy was about 85%, regardless of the NAC regimen. A lower creatinine clearance and the delivery of less than four cycles were associated with a higher risk of relapse. Predicting the efficacy of NAC remains a major challenge. The planned analysis of molecular subtypes in the VESPER trial could help predict which patients may achieve complete response and better outcome.
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