Abstract：
OBJECTIVE: To compare survival and pathologic outcomes in patients with progressive muscle-invasive bladder cancer (pgMIBC) and de novo muscle-invasive bladder cancer (dnMIBC) after radical cystectomy (RC), with a focus on the role of neoadjuvant chemotherapy (NAC).
METHODS: A comprehensive literature search was conducted on PubMed and EMBASE databases to identify studies comparing pgMIBC to dnMIBC. Survival outcomes, including cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS), and pathologic outcomes (rates of ≤pT1, pT0, pT3/T4, and pN+ disease) were compared between pgMIBC and dnMIBC.
RESULTS: The analysis included 19 cohorts from 16 studies, categorized into 3 groups based on NAC use: 1. patients who underwent RC and were all treated with NAC (RC + NAC only group); 2. patients who underwent RC, with or without NAC (RC +/- NAC group); 3. patients who only underwent RC without NAC (RC only group). Compared to dnMIBC, pgMIBC demonstrated worse outcomes for CSS, OS, and RFS. In the RC + NAC only group (3 cohorts), the hazard ratio (HR) for CSS was 1.52 (95% confidence interval [CI] = 1.05-2.2), while the HR for OS was 1.46 (95%CI = 1.05-2.02). Similarly, in the RC +/- NAC group (6 cohorts for CSS and 3 cohorts for OS), the HR for CSS was 1.27 (95%CI = 1.05-1.55), and the HR for OS was 1.27 (95%CI = 1.08-1.51). There were no significant differences observed in pathologic outcomes, including rates of ≤pT1, pT0, and pT3/T4 disease, across all subgroups. However, pgMIBC was associated with a higher risk of nodal metastatic (pN+) disease in the RC + NAC only group (4 cohorts, relative risk [RR] = 1.43, 95%CI = 1.12-1.84).
CONCLUSIONS: The findings highlight the potentially worse prognosis in patients with pgMIBC compared to dnMIBC, even with the modern use of NAC. The study emphasizes the importance of careful patient counseling, further classification of patients for treatment selection, and the consideration of additional or innovative systemic therapies for pgMIBC.
METHODS: A comprehensive literature search was conducted on PubMed and EMBASE databases to identify studies comparing pgMIBC to dnMIBC. Survival outcomes, including cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS), and pathologic outcomes (rates of ≤pT1, pT0, pT3/T4, and pN+ disease) were compared between pgMIBC and dnMIBC.
RESULTS: The analysis included 19 cohorts from 16 studies, categorized into 3 groups based on NAC use: 1. patients who underwent RC and were all treated with NAC (RC + NAC only group); 2. patients who underwent RC, with or without NAC (RC +/- NAC group); 3. patients who only underwent RC without NAC (RC only group). Compared to dnMIBC, pgMIBC demonstrated worse outcomes for CSS, OS, and RFS. In the RC + NAC only group (3 cohorts), the hazard ratio (HR) for CSS was 1.52 (95% confidence interval [CI] = 1.05-2.2), while the HR for OS was 1.46 (95%CI = 1.05-2.02). Similarly, in the RC +/- NAC group (6 cohorts for CSS and 3 cohorts for OS), the HR for CSS was 1.27 (95%CI = 1.05-1.55), and the HR for OS was 1.27 (95%CI = 1.08-1.51). There were no significant differences observed in pathologic outcomes, including rates of ≤pT1, pT0, and pT3/T4 disease, across all subgroups. However, pgMIBC was associated with a higher risk of nodal metastatic (pN+) disease in the RC + NAC only group (4 cohorts, relative risk [RR] = 1.43, 95%CI = 1.12-1.84).
CONCLUSIONS: The findings highlight the potentially worse prognosis in patients with pgMIBC compared to dnMIBC, even with the modern use of NAC. The study emphasizes the importance of careful patient counseling, further classification of patients for treatment selection, and the consideration of additional or innovative systemic therapies for pgMIBC.
摘要：
目的：比较根治性膀胱切除术（RC）后进行性肌层浸润性膀胱癌（pgMIBC）和新生肌层浸润性膀胱癌（dnMIBC）患者的生存和病理结果，重点介绍了新辅助化疗（NAC）的作用。
方法：在PubMed和EMBASE数据库上进行了全面的文献检索，以确定将pgMIBC与dnMIBC进行比较的研究。生存结果,包括癌症特异性生存率（CSS），总生存期（OS），和无复发生存率（RFS），比较了pgMIBC和dnMIBC的病理结局(≤pT1,pT0,pT3/T4和pN+疾病的发生率).
结果：分析包括来自16项研究的19个队列，根据NAC的使用分为3组：1.接受RC且均接受NAC治疗的患者(仅RC+NAC组);2.接受RC的患者，有或没有NAC(RC+/-NAC组);3.仅接受RC而不接受NAC的患者（仅RC组）。与dnMIBC相比,pgMIBC对CSS表现出更差的结果，操作系统,和RFS。在仅RC+NAC组(3个队列)中，CSS的风险比（HR）为1.52（95％置信区间[CI]=1.05-2.2），而OS的HR为1.46（95CI=1.05-2.02）。同样，在RC+/-NAC组中（CSS为6个队列，OS为3个队列），CSS的HR为1.27（95CI=1.05-1.55），OS的HR为1.27（95CI=1.08-1.51）。在病理结果中没有观察到显著差异,包括≤pT1、pT0和pT3/T4疾病的发病率，在所有子组。然而,在仅RC+NAC组中，pgMIBC与淋巴结转移（pN+）疾病的风险较高相关（4个队列，相对风险[RR]=1.43，95CI=1.12-1.84）。
结论：研究结果强调了pgMIBC患者与dnMIBC相比的预后可能更差，即使现代使用NAC。这项研究强调了认真患者咨询的重要性，进一步分类的患者进行治疗选择，并考虑对pgMIBC进行额外或创新的系统治疗。
方法：在PubMed和EMBASE数据库上进行了全面的文献检索，以确定将pgMIBC与dnMIBC进行比较的研究。生存结果,包括癌症特异性生存率（CSS），总生存期（OS），和无复发生存率（RFS），比较了pgMIBC和dnMIBC的病理结局(≤pT1,pT0,pT3/T4和pN+疾病的发生率).
结果：分析包括来自16项研究的19个队列，根据NAC的使用分为3组：1.接受RC且均接受NAC治疗的患者(仅RC+NAC组);2.接受RC的患者，有或没有NAC(RC+/-NAC组);3.仅接受RC而不接受NAC的患者（仅RC组）。与dnMIBC相比,pgMIBC对CSS表现出更差的结果，操作系统,和RFS。在仅RC+NAC组(3个队列)中，CSS的风险比（HR）为1.52（95％置信区间[CI]=1.05-2.2），而OS的HR为1.46（95CI=1.05-2.02）。同样，在RC+/-NAC组中（CSS为6个队列，OS为3个队列），CSS的HR为1.27（95CI=1.05-1.55），OS的HR为1.27（95CI=1.08-1.51）。在病理结果中没有观察到显著差异,包括≤pT1、pT0和pT3/T4疾病的发病率，在所有子组。然而,在仅RC+NAC组中，pgMIBC与淋巴结转移（pN+）疾病的风险较高相关（4个队列，相对风险[RR]=1.43，95CI=1.12-1.84）。
结论：研究结果强调了pgMIBC患者与dnMIBC相比的预后可能更差，即使现代使用NAC。这项研究强调了认真患者咨询的重要性，进一步分类的患者进行治疗选择，并考虑对pgMIBC进行额外或创新的系统治疗。
