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Open Access 01-12-2023 | Metastasis | Research

Clinical application and efficacy analysis of partial cystectomy combined with intravesical chemotherapy in muscle-invasive bladder cancer

Authors: Bin Zhang, Tengfei Liu, Yang He, Dali Han, Peng Qi, Duo Zheng, Junyao Liu, Xingxing Zhang, Zhongjin Yue, Panfeng Shang

Published in: BMC Urology | Issue 1/2023

Abstract

Objectives

Comparing the long-term tumor control results of partial cystectomy(PC)and radical cystectomy(RC)in the treatment of muscle-invasive bladder cancer, and to explore the feasible method of bladder preservation therapy (BPT)in patients with MIBC.

Methods

We retrospectively analyzed the clinical data of 102 patients with muscle-invasive bladder cancer in our hospital between January 2012 and December 2018, of whom 32 cases in the partial cystectomy group and 70 cases in the radical cystectomy group. We performed a comparative analysis of patient general information, perioperative-related indicators and postoperative follow-up data, comparing OS, PFS, and DSS at 1, 2, 3, 4, and 5 years in both groups, and comparing tumour recurrence and metastasis in postoperative patients.

Results

All the 102 cases in this study were successfully completed. Partial cystectomy group and Radical cystectomy group median operating time (169.50(130.00 ~ 225.25) min and 420.00(343.75 ~ 483.75) min, p < 0.001), median intraoperative blood loss was (100(50 ~ 100)ml and 400(200 ~ 1000)ml, p < 0.001), median perioperative blood transfusion volume (0(0 ~ 0)ml and 600(150.00 ~ 906.25)ml, p < 0.001), median total hospital stay (18(14.25 ~ 20.00) and 24.5(20.00 ~ 34.25) days, p < 0.001), median preoperative preparation time (7(4.25 ~ 8.00) and 10(8.00 ~ 13.00) days, p < 0.001), median postoperative hospital stay (9(8.00 ~ 13.50) and 14(11.00 ~ 21.25) days, p < 0.001), the incidence of perioperative blood transfusion was (15.6% and 75.7%, p < 0.001), the incidence of surgical complications was(28.1%(9/32) and 50.0%(35/70), p = 0.033), average hospitalization cost ((26435.76 ± 9877.82) yuan and (58464.36 ± 19753.13) yuan, p < 0.001), the differences were statistically significant (p < 0.05). Perioperative mortality (0 vs. 2.9%(2/70), p = 1), and OS at 1, 2, 3, 4, and 5 years after surgery were (80.0%, 59.8%, 56.1%, 51.0%, 44.6% vs. 76.5%, 67.4%, 64.9%, 57.9%, 52.6%, p = 0.524), PFS (68.2%, 64.6%, 60.3%, 54.8%, 54.8% vs. 82.7%, 78.3%, 75.4%, 67.3%, 62.1%, p = 0.259). DSS (89.9%, 72.4%, 68.6%, 68.6%, 62.4% vs. 87.3%, 83.4%, 80.9%, 73.6%, 68.0%, p = 0.424), and the incidence of tumor recurrence or metastasis was (40.0%(12/30) vs. 25.4%(16/63), p = 0.151), the differences were not statistically significant (p > 0.05).

Conclusion

In patients with limited solitary T2N0M0 and T3N0M0 muscle-invasive bladder cancer, partial cystectomy plus bladder instillations treatment can achieve comparable tumour control to radical cystectomy. However, patients in the PC group have significant advantages in terms of operative time, intraoperative bleeding, intraoperative and postoperative blood transfusion, preoperative preparation time, total hospital stay, postoperative recovery time, operative costs and operative complications. This option may be considered for such patients with a need for bladder preservation.

Lenis AT, Lec PM, Chamie K, Mshs MD, Bladder Cancer. Rev JAMA. 2020 Nov;17(19):1980–91. https://doi.org/10.1001/jama.2020.17598

Kamat AM, Hahn NM, Efstathiou JA, Lerner SP, Malmström PU, Choi W, Guo CC, Lotan Y, Kassouf W. Bladder cancer. Lancet. 2016 Dec 3;388(10061):2796–2810. doi: https://doi.org/10.1016/S0140-6736(16)30512-8

Perera M, McGrath S, Sengupta S, Crozier J, Bolton D, Lawrentschuk N. Pelvic lymph node dissection during radical cystectomy for muscle-invasive bladder cancer. Nat Rev Urol 2018 Nov;15(11):686–92. doi: https://doi.org/10.1038/s41585-018-0066-1

Catto JWF, Khetrapal P, Ricciardi F, Ambler G, Williams NR, Al-Hammouri T, Khan MS, Thurairaja R, Nair R, Feber A, Dixon S, Nathan S, Briggs T, Sridhar A, Ahmad I, Bhatt J, Charlesworth P, Blick C, Cumberbatch MG, Hussain SA, Kotwal S, Koupparis A, McGrath J, Noon AP, Rowe E, Vasdev N, Hanchanale V, Hagan D, Brew-Graves C, Kelly JD. ; iROC Study Team. Effect of Robot-Assisted Radical Cystectomy With Intracorporeal Urinary Diversion vs Open Radical Cystectomy on 90-Day Morbidity and Mortality Among Patients With Bladder Cancer: A Randomized Clinical Trial. JAMA 2022 Jun 7;327(21):2092–103. doi: https://doi.org/10.1001/jama.2022.7393

Bochner BH, Dalbagni G, Sjoberg DD, Silberstein J, Keren Paz GE, Donat SM, Coleman JA, Mathew S, Vickers A, Schnorr GC, Feuerstein MA, Rapkin B, Parra RO, Herr HW, Laudone VP. Comparing Open Radical Cystectomy and Robot-assisted laparoscopic radical cystectomy: a Randomized Clinical Trial. Eur Urol. 2015 Jun;67(6):1042–50. https://doi.org/10.1016/j.eururo.2014.11.043

Mastroianni R, Ferriero M, Tuderti G, Anceschi U, Bove AM, Brassetti A, Misuraca L, Zampa A, Torregiani G, Ghiani E, Giannarelli D, Guaglianone S, Gallucci M, Simone G. Open Radical Cystectomy versus Robot-Assisted radical cystectomy with intracorporeal urinary diversion: early outcomes of a Single-Center Randomized Controlled Trial. J Urol. 2022 May;207(5):982–92. https://doi.org/10.1097/JU.0000000000002422

Alfred Witjes J, Lebret T, Compérat, Eva M et al. Updated 2016 EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer. Eur Urol 2017 Mar;71(3):462–75. doi: https://doi.org/10.1016/j.eururo.2016.06.020

Milowsky MI, Rumble RB, Booth CM et al. Guideline on Muscle-Invasive and Metastatic Bladder Cancer (European Association of Urology Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement. J Clin Oncol. 2016 Jun 1;34(16):1945-52. doi: https://doi.org/10.1200/JCO.2015.65.9797

Kaneti J. Partial cystectomy in the management of bladder carcinoma. Eur Urol. 1986;12(4):249–52. https://doi.org/10.1159/000472629CrossRefPubMed

10.

Mylona E, Ebert M, Kennedy A, Joseph D, Denham J, Steigler A, Supiot S, Acosta O, de Crevoisier R. Rectal and Urethro-Vesical Subregions for Toxicity Prediction After Prostate Cancer Radiation Therapy: Validation of Voxel-Based Models in an Independent Population. Int J Radiat Oncol Biol Phys 2020 Dec 1;108(5):1189–95. doi: https://doi.org/10.1016/j.ijrobp.2020.07.019

11.

Witjes JA, Bruins HM, Cathomas R, Compérat EM, Cowan NC, Gakis G, Hernández V, Linares Espinós E, Lorch A, Neuzillet Y, Rouanne M, Thalmann GN, Veskimäe E, Ribal MJ, van der Heijden AG. European Association of Urology Guidelines on muscle-invasive and metastatic bladder Cancer: Summary of the 2020 guidelines. Eur Urol. 2021 Jan;79(1):82–104. https://doi.org/10.1016/j.eururo.2020.03.055

12.

Wang Jiaji Y, Li Y, Zhongjin, et al. Laparoscopic total cystectomy--Mainz II cystectomy was reported in 6 cases. Chin J Minim invasive Surg. 2011;11(4):322–4.

13.

Chung R, Moran GW, Wang C, McKiernan JM, Anderson CB. Partial cystectomy: Review of a single center experience from 2004 to 2019. Urol Oncol. 2022 Dec;40(12):538.e1-538.e5. doi: https://doi.org/10.1016/j.urolonc.2022.09.003

14.

Mistretta FA, Cyr SJ, Luzzago S, Mazzone E, Knipper S, Palumbo C, Tian Z, Nazzani S, Saad F, Montanari E, Tilki D, Briganti A, Shariat SF, de Cobelli O, Karakiewicz PI. Partial cystectomy with pelvic lymph node dissection for patients with Nonmetastatic Stage pT2-T3 urothelial carcinoma of urinary bladder: temporal Trends and Survival Outcomes. Clin Genitourin Cancer. 2020 Apr;18(2):129–137e3. https://doi.org/10.1016/j.clgc.2019.09.008

15.

Brocklehurst A, Varughese M, Birtle A. Bladder preservation for muscle-invasive bladder Cancer with variant histology. Semin Radiat Oncol. 2023 Jan;33(1):62–9. https://doi.org/10.1016/j.semradonc.2022.10.008

16.

Smith ZL, Christodouleas JP, Keefe SM et al. Bladder preservation in the treatment of muscle-invasive bladder cancer (MIBC): a review of the literature and a practical approach to therapy[J]. BJU International, 2013, 112(1):13–25.doi: https://doi.org/10.1111/j.1464-410X.2012.11762.x

17.

Soloway M S. ICUD-EAU International Consultation on Bladder Cancer 2012: Recommendations on Bladder Cancer—Progress in a Cancer that Lacks the Limelight[J]. European Urology, 2013, 63(1):1–3.doi: https://doi.org/10.1016/j.eururo.2012.07.045

18.

Panos G, Mulita F, Akinosoglou K, Liolis E, Kaplanis C, Tchabashvili L, Vailas M, Maroulis I. Risk of surgical site infections after colorectal surgery and the most frequent pathogens isolated: a prospective single-centre observational study. Med Glas (Zenica). 2021 Aug 1;18(2):438–443.doi: https://doi.org/10.17392/1348-21

19.

Mulita F, Papadopoulos G, Tsochatzis S, Kehagias I. Laparoscopic removal of an ingested fish bone from the head of the pancreas: case report and review of literature. Pan Afr Med J 2020 Jun 25;36:123doi: https://doi.org/10.11604/pamj.2020.36.123.23948

20.

Fujii Y, Kihara K, Tanaka H, et al., MP65-04 ONCOLOGICAL AND FUNCTIONAL OUTCOMES IN MUSCLE-INVASIVE BLADDER CANCER PATIENTS UNDERGOING BLADDER-SPARING TREATMENT CONSISTING OF LOW-DOSE CHEMORADIOTHERAPY AND CONSOLIDATIVE PARTIAL CYSTECTOMY[J], et al. J Urol. 2015;193(4):e808.

21.

Longo N, Celentano G, Napolitano L, La Rocca R, Capece M, Califano G, Collà Ruvolo C, Mangiapia F, Fusco F, Morra S, Turco C, Di Bello F, Fusco GM, Cirillo L, Cacciapuoti C, Spirito L, Calogero A, Sica A, Sagnelli C, Creta M. Metastasis-Directed Radiation Therapy with Consolidative Intent for Oligometastatic Urothelial Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel). 2022 May 11;14(10):2373. doi: https://doi.org/10.3390/cancers14102373

22.

Chalasani V, Chin JL, Izawa JI. Histologic variants of urothelial bladder cancer and nonurothelial histology in bladder cancer[J]. Can Urol Association J. 2013;3:6–S4.

23.

Pieretti A, Krasnow R, Drumm M, Gusev A, Dahl DM, McGovern F, Blute ML, Shipley WU, Efstathiou JA, Feldman AS, Wszolek MF. Complications and outcomes of Salvage Cystectomy after Trimodality Therapy. J Urol. 2021 Jul;206(1):29–36. https://doi.org/10.1097/JU.0000000000001696

24.

Kijima T, Tanaka H, Uehara S, Yoshida S, Yokoyama M, Ishioka J, Matsuoka Y, Saito K, Kihara K, Fujii Y. Clinical outcomes of patients with histologic variants of Urothelial Carcinoma treated with selective tetramodal bladder-preservation therapy incorporating consolidative partial cystectomy. Clin Genitourin Cancer. 2020 Aug;18(4):268–273e2. https://doi.org/10.1016/j.clgc.2019.11.005

25.

van Hoogstraten LMC, Witjes JA, Meijer RP, Ripping TM, BlaZIB study group, Kiemeney LA, Aben KKH. Non-metastatic muscle-invasive bladder cancer: the role of age in receiving treatment with curative intent. BJU Int. 2022 Dec;130(6):764–75. https://doi.org/10.1111/bju.15697

Title: Clinical application and efficacy analysis of partial cystectomy combined with intravesical chemotherapy in muscle-invasive bladder cancer
Authors: Bin Zhang
Tengfei Liu
Yang He
Dali Han
Peng Qi
Duo Zheng
Junyao Liu
Xingxing Zhang
Zhongjin Yue
Panfeng Shang
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Metastasis
Cystectomy
Published in: BMC Urology / Issue 1/2023
Electronic ISSN: 1471-2490
DOI: https://doi.org/10.1186/s12894-023-01267-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical application and efficacy analysis of partial cystectomy combined with intravesical chemotherapy in muscle-invasive bladder cancer

Abstract

Objectives

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

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