Considerations in the Use of Neoadjuvant and Adjunctive Systemic Chemotherapy in Treatment of Invasive Bladder Cancer by Cystectomy

摘要: Approximately 10,000 cases of muscle invasive bladder cancer are diagnosed in the United States each year, representing about 20% new urinary tract malignancy (1). Results from contemporary radical cystectomy and pelvic lymph node dissection for T2-4NXM0 transitional cell carcinoma (TCC) indicate that this operation is safe with a surgical mortality rate 0.5%–6%. Radical accomplishes excellent, durable, local control primary tumor, provides accurate pathologic staging tumor nodes, and, due to increasing expertise continent diversion, affords preservation quality life (2). Despite these advances, 5-yr survival all patients pT2 tumors 50%–80%, negative nodes having 64%–86% survival. The rates regionally advanced cancers, pT3 pT4, series range 22%–58%. Among pathologically proven metastasis, probability following only 29% (3). 50% nodal metastases confined muscularis propria, whereas more tumors, drops significantly 18% or less.