Abstract
The aim of the study was to evaluate the value of clinical prognostic factors for survival of patients with invasive urinary bladder cancer treated with radical cystectomy, chemotherapy, and radiotherapy. A total of 115 patients with invasive urinary bladder cancer were analyzed. Twenty-three patients with invasive urinary bladder cancer (pT2-T4) were treated according to the protocol of a prospective clinical study. In all the cases, transurethral resection was followed by radiation and chemotherapy. A total dose of 54-60 Gy of radiotherapy was delivered by daily fractions of 1.8-2.0 Gy each. Simultaneous chemotherapy was started on the same day as radiotherapy; gemcitabine at a dose of 175-300 mg/m(2) was delivered once a week intravenously for 6 weeks. Individual patient data was analyzed in a retrospective part of the study. Radical cystectomy was performed to 46 patients with invasive urinary bladder cancer, and radiotherapy was delivered to 46 patients. Inclusion criteria for patients into a prospective or retrospective trial were equal. We evaluated a prognostic value of various clinical factors for patients treated with radical cystectomy, chemoradiation with gemcitabine, and radiation alone. The 3-year overall survival in the cystectomy group was 51.1%, in the chemoradiation group 38.0%, and in the radiotherapy group 26.9% (P=0.001). In univariate analysis in the chemoradiation group, completion of treatment according to the protocol showed a significant influence on overall survival (P=0.03). In the radiation group, completion of treatment according to the protocol showed a significant influence on overall survival too (P=0.01). In the radical cystectomy group, an important factor was a complete or incomplete TUR (P=0.02). Multivariate analysis showed a significance of hydronephrosis (P=0.03) and T stage (P=0.04) in the radiation therapy group. Comorbidity was found to be an independent prognostic factors in the chemoradiation group (P=0.02). The best 3-year overall survival was in the radical cystectomy group. Chemoradiation with gemcitabine could be offered as an alternative to patients refusing cystectomy. Better overall survival in the chemoradiation group was for patients without comorbidities and when treatment protocol was completed.
Highlights
Urinary bladder cancer is the second most common urological malignancy in males
The best 3-year overall survival was in the radical cystectomy group
Some clinical studies showed that disease-related clinical prognostic factors influencing treatment response in invasive urinary bladder cancer treated by surgery and conservative therapy are the stage of the disease (T stage of tumor), hydronephrosis, and number of lymph nodes involved in patients treated with radical cystectomy
Summary
Urinary bladder cancer is the second most common urological malignancy in males. A 5-year survival rate for patients with invasive urinary bladder cancer is 20–70%, because invasive urinary bladder cancer tends to metastasize. The survival in patients with invasive urinary bladder cancer is poor. Treatment protocols based on transurethral resection of bladder tumor (TURBT), radiotherapy, and chemotherapy have been investigated and used in clinical practice for more than two decades. Until now it remains unclear which conservative regimen is an optimal choice with little toxicity and good survival results. Clinical factors that can have an impact on treatment response and overall survival have been identified Until now it is not clear which factors could help to choose between the treatment methods – surgery or conservative bladder-sparing treatment
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