Objectives

To determine the impact of prior pelvic radiation therapy (XRT) on outcomes following radical cystectomy (RC) for bladder cancer.

Materials and methods

We performed a retrospective review comparing patients with bladder cancer requiring RC and prior history of XRT for prostate cancer to those undergoing RC without XRT history at our institution from 2011-2018. Propensity score matching was performed with the following variables: age, chronic kidney disease, nutritional deficiency, neoadjuvant chemotherapy use, Charlson comorbidity index, surgical approach, urinary diversion type, and pathologic T-stage. Perioperative, pathologic and oncologic outcomes were analyzed.

Outcome measurements and statistical analysis

Categorical variables were assessed utilizing the Pearson Chi Square Test, and continuous variables with the Wilcoxon rank-sum test. The Kaplan-Meier method with stratified-log rank was used to compare survival outcomes. Multivariable Cox proportional hazards models were utilized to identify predictors of overall and recurrence free survival.

Results

227 patients were included, of which 47 had radiotherapy for prostate cancer. 47% of patients in the radiation cohort received external beam radiation therapy, 47% received brachytherapy and 7% received both. There were no differences in recurrence-free survival (P = 0.82) or overall survival (P = 0.25). Statistically significant differences in perioperative or postoperative outcomes such as 90-day complication, readmission, mortality rates, or ureteroenteric anastomotic stricture rates were not found. Rates of node-positive disease, median lymph node yield, positive surgical margin rates, lymphovascular invasion, or variant histology were not significantly different between cohorts.

Conclusions

After matching for T-stage and other clinical variables, history of pelvic XRT for prostate cancer in patients who later required RC for bladder cancer, was not associated with an increased rate of perioperative complications or an independent predictor of RFS or OS.

中文翻译：

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前列腺癌盆腔放疗患者根治性膀胱切除术后的生存结果：匹配队列分析

目标

确定先前盆腔放射治疗 (XRT) 对膀胱癌根治性膀胱切除术 (RC) 后结果的影响。

材料和方法

我们进行了一项回顾性研究，比较了 2011-2018 年在我们机构接受 RC 和前列腺癌 XRT 既往史的膀胱癌患者与没有 XRT 史的膀胱癌患者。使用以下变量进行倾向评分匹配：年龄、慢性肾脏疾病、营养缺乏、新辅助化疗的使用、Charlson 合并症指数、手术方法、尿流改道类型和病理 T 分期。对围手术期、病理学和肿瘤学结果进行了分析。

结果测量和统计分析

分类变量使用 Pearson 卡方检验评估，连续变量使用 Wilcoxon 秩和检验。具有分层对数秩的 Kaplan-Meier 方法用于比较生存结果。利用多变量 Cox 比例风险模型来确定总体和无复发生存的预测因子。

结果

纳入 227 名患者，其中 47 名接受了前列腺癌放疗。放射队列中 47% 的患者接受了外束放射治疗，47% 接受了近距离放射治疗，7% 接受了两者。无复发生存期（P  = 0.82）或总生存期（P  = 0.25）没有差异。未发现围手术期或术后结果（如 90 天并发症、再入院、死亡率或输尿管肠吻合口狭窄率）存在统计学显着差异。淋巴结阳性疾病率、中位淋巴结产量、阳性手术切缘率、淋巴血管侵犯或变异组织学在队列之间没有显着差异。

结论

在匹配 T 分期和其他临床变量后，对于后来需要 RC 治疗膀胱癌的患者，盆腔 XRT 治疗前列腺癌的病史与围手术期并发症发生率的增加或 RFS 或 OS 的独立预测因素无关。