Salvage radical cystectomy after organ preservation therapy in patients with undifferentiated bladder cancer: its place in the treatment algorithm and survival results
DOI:
https://doi.org/10.14739/2310-1210.2020.5.214743Keywords:
undifferentiated bladder cancer, partial cystectomy, recurrence, salvage cystectomy, survival, radiotherapyAbstract
Undifferentiated bladder cancer (G4 UBC) is aggressive disease with high potential for metastatis and local recurrence. All patients have muscle invasive disease at a presentation, which requires radical cystectomy (RCE).
Purpose: to study current treatment modalities applied to G4 UBC patients, survival outcomes, the place of salvage cystectomy after organ-preserving treatment.
Materials and methods. During 1998–2016, we treated 63 patients with G4 UBC, or 1.8 % of all UBC patients. We analyzed clinical data, treatment methods, and survival data. Kaplan-Meier method was used for comparative survival analysis between G4 UBC patients who developed recurrence after organ-preserving treatment and those who did not.
Results. All patients had ≥рТ2 stage disease. Treatment with curative intent was delivered to 78 % patients – resection of the bladder (49 %), RCE (29%). Survival at 5 years was 11 %. Recurrence after resection was diagnosed in 35 % of patients. Salvage cystectomy was performed in 6 patients with median survival of 7 months vs. 47 months after RCE. Patients also demonstrated high median survival after combined treatment: after resection with adjuvant radiotherapy to the bladder (44 months), and RCE with adjuvant chemotherapy (12 years). Survival of patients with recurrence and further special treatment turned out to be better than in patients without recurrence (P = 0.005).
Conclusions. Radical cystectomy demonstrates better survival results in managing G4 РСМ patients than salvage cystectomy. Organ-preserving treatment combined with radiotherapy demonstrates survival outcomes comparable to those after radical cystectomy.
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