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The effects of intra-arterial chemotherapy on bladder preservation in patients with T1 stage bladder cancer

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Abstract

Purpose

To investigate the effects of intra-arterial chemotherapy on T1 stage bladder cancer (Bca) and evaluate patient outcome with bladder-preserving treatment approaches.

Materials and methods

A total of 238 patients with T1 stage Bca were retrospectively analyzed. Among them, 35 patients were categorized into the subgroup of highest-risk T1 stage according to the European Association of Urology guidelines and received immediate radical cystectomy (RC group), whereas 62 were classified as being highest-risk T1 patients but were unwilling to undergo RC and were treated with gemcitabine plus cisplatin intra-arterial chemotherapy (GC group). There were 141 T1 patients who had bladder-preserving surgery with intravesical chemotherapy (IVC group).

Results

For patients with T1 stage Bca, the GC group had a higher estimated recurrence-free survival rate (44.4 vs. 13.9%, P = 0.087), progression-free survival rate (75.4 vs. 32.8%, P = 0.006), and cancer-specific survival (CSS) rate (78.7 vs. 67.5%, P = 0.399) when compared with the IVC group, respectively. Using the multivariable regression model, the GC intra-arterial chemotherapy was significantly related to bladder preservation (P = 0.004), lower recurrence (P = 0.012), and less progression (P = 0.004). For patients with the highest-risk T1 stage, GC group did not have a poorer CSS rate in comparison with the RC group (P = 0.383). Moreover, immediate RC did not confer a survival benefit in terms of CSS when compared with those who underwent deferred RC after failing GC intra-arterial chemotherapy (P = 0.283).

Conclusions

Gemcitabine plus cisplatin intra-arterial chemotherapy may be an effective bladder-preserving alternative adjuvant treatment for patients with T1 stage Bca with oncologic benefits, good compliance, and low toxicity.

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Authors and Affiliations

  1. Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, 510060, China

    Zefu Liu, Yunlin Ye, Xiangdong Li, Shengjie Guo, Lijuan Jiang, Pei Dong, Yonghong Li, Kai Yao, Zike Qin, Hui Han, Fangjian Zhou & Zhuowei Liu

  2. Department of Medical Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China

    Yanxia Shi

  3. Department of Imaging and Interventional Radiology, Cancer Center, Sun Yat-sen University, Guangzhou, China

    Weijun Fan

  4. Department of Pathology, Cancer Center, Sun Yat-sen University, Guangzhou, China

    Yun Cao

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  1. Zefu Liu
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Contributions

ZF Liu: project development, data collection and management, data analysis, manuscript writing. YL Ye: project development, data collection and management, manuscript editing. XD Li: data analysis, manuscript editing. SJ Guo: project development, manuscript editing. JL Juan: project development, manuscript editing. P Dong: project development, data collection. YH Li: project development. YX Shi: project development. Y Cao: project development. ZK Qin: project development. H Han: project development. FJ Zhou: project development, manuscript editing. ZW Liu: project development, data analysis, manuscript editing.

Corresponding authors

Correspondence to Fangjian Zhou or Zhuowei Liu.

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Liu, Z., Ye, Y., Li, X. et al. The effects of intra-arterial chemotherapy on bladder preservation in patients with T1 stage bladder cancer. World J Urol 36, 1191–1200 (2018). https://doi.org/10.1007/s00345-018-2199-5

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  • DOI: https://doi.org/10.1007/s00345-018-2199-5

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