Abstract

BACKGROUND:

Cisplatin-based neoadjuvant chemotherapy (NAC) has shown overall survival benefit for patients with muscle invasive bladder cancer (MIBC). In contrast, there is limited data for adjuvant treatment options in patients with residual muscle-invasive disease after NAC followed by radical cystectomy (RC).

OBJECTIVE:

This systematic review aims to give an overview of studies examining adjuvant treatment options for patients with residual MIBC at RC despite NAC.

METHODS:

We systematically searched the PubMed database and Clinicaltrials.gov (end point August 2019) for publications and registered trials combining NAC, RC, and adjuvant treatment options.

RESULTS:

After removal of duplicates, 659 articles and registered trials were further analyzed. Finally, 10 studies and 7 registered clinical trials met inclusion criteria. While 5 publications did not further characterize NAC and adjuvant regimens, the remaining 5 studies reported mainly platinum-based regimens. Altogether, the selected studies showed conflicting results regarding the potential role of adjuvant treatment strategies in the setting of residual disease after NAC and RC.

CONCLUSION:

Although there is an urgent need for adjuvant treatment options for patients with MIBC after NAC and residual muscle-invasive disease at RC, there has been very limited evidence available. Inclusion of such patients into ongoing adjuvant clinical trials is urgently needed; active surveillance is strongly recommended in the absence of trials.

中文翻译：

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新辅助化学疗法和根治性膀胱切除术治疗肌肉浸润性膀胱癌后残留疾病的辅助治疗

摘要

背景：

基于顺铂的新辅助化疗（NAC）对患有肌肉浸润性膀胱癌（MIBC）的患者显示出总体生存获益。相反，在NAC后行根治性膀胱切除术（RC）后残留肌肉浸润性疾病的患者中，辅助治疗选择的数据有限。

目的：

本系统综述旨在概述研究尽管有NAC，但对于RC残留的MIBC患者的辅助治疗选择的研究。

方法：

我们系统地搜索了PubMed数据库和Clinicaltrials.gov（截至2019年8月），以查找结合NAC，RC和辅助治疗方案的出版物和注册试验。

结果：

删除重复项后，对659篇文章和注册的试验进行了进一步分析。最后，有10项研究和7项注册的临床试验符合纳入标准。尽管5篇出版物没有进一步描述NAC和辅助方案的特征，但其余5篇研究报告了主要基于铂的方案。总的来说，所选的研究显示出在NAC和RC后残留治疗中辅助治疗策略潜在作用的矛盾结果。

结论：

尽管急需在NAC和RC残留的肌肉浸润性疾病后对MIBC患者进行辅助治疗，但可用的证据非常有限。迫切需要将此类患者纳入正在进行的辅助临床试验中；强烈建议在没有试验的情况下进行主动监视。