Neoadjuvant chemotherapy (NAC) with radical cystectomy (RC) is the recommended treatment for muscle invasive bladder tumors (MIBC). However, more than half of patients are unable to undergo NAC due to contraindications. The aim of the study is to evaluate the long‐term oncological results from one tertiary center and thus demonstrate the effectiveness of neoadjuvant chemotherapy in muscle‐invasive bladder tumors. Methods: In the years 2010-2021, 100 patients with MIBC underwent neoadjuvant (for cN0) / induction (for cN+) chemotherapy - most often as a combination of cisplatin and gemcitabine. Patients with cT3-4 or cN+ were indicated for NAC; in the subgroup of cT2N0, the patients were selected according to risk factors. Out of a of 100 patients, 49 were without lymphadenopathy (cN0) and 51 with enlarged nodes (cN1-3). Progression occurred in 8 patients during NAC (2× in cN0, 6× in cN+), two patients refused surgical treatment after NAC. Subsequent radical cystectomy was performed in 47/49 cN0 and 43/51 cN1-3 patients. The study evaluated the intention‐to‐treat population, even the patients who did not undergo surgical treatment were included. We assessed five‐year cancer‐specific survival (CSS) using Kaplan‐Meier curves and compared survival within subgroups using the log‐rank test. Response to chemotherapy was defined as complete (pCR - ypT0N0), partial (pPR ≤ ypT1N0) or no response (non‐R; ≥ypT2N0-3). The influence of clinical and histopathological parameters on progression‐free survival (PFS) was evaluated using the Cox regression model. Median follow‐up was 43 months (IQR 16-87). Results: The average age of the patients was 64 years, men and women comprised 76% and 24% of the cohort, respectively. The extent of the primary tumor was cT2 in 39 and cT3-4 in 61 cases. The median number of lymph nodes removed during procedure was 24 (IQR 19;29). Five‐year CSS reached 84% in cT2-4N0 and 52% in cT2-4N1-3. Five‐year CSS was not different for cN1 versus cN2-3 (53% and 50%, respectively). We recorded a response to chemotherapy (cCR+pCR) in 34/49 (69%) patients with cN0 and in 24/51 (47%) cN1-3. Achieving response to chemotherapy improved 5-year CSS in both subgroups, in cN0 patients 93% versus 60% (p=0.001), in cN1-3 85% versus 27% (p<0.001). In the entire group, the 30-day and 90-day mortality reached 0% and 3%, respectively. In multivariate analysis, significant predictors of progression‐free survival were initial nodal involvement (HR 2.92; p=0.007) and failure to respond to NAC (HR 6.56; p≤0.001) Conclusion: In patients with invasive bladder cancer who are treated with neoadjuvant chemotherapy followed by radical cystectomy, excellent oncological results can be achieved in clinically localized disease. Even in the case of clinical lymphadenopathy, up to half of patients survive five years. Achieving a response to chemotherapy and the absence of lymphadenopathy at the time of diagnosis reduce the risk of recurrence.
- MeSH
- cystektomie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfadenopatie MeSH
- nádory močového měchýře * terapie MeSH
- neoadjuvantní terapie * MeSH
- přežití bez známek nemoci MeSH
- protokoly protinádorové léčby MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
Uvádíme kazuistiku extrémně vzácné komplikace u jinak velmi frekventovaného urologického zákroku, kterým je zajištění derivace moči zavedením double J stentu při obstrukci odtoku z horních cest močových. V našem případě u pacientky po zavedení double J stentu pro urinózní sekreci z drénu po rozsáhlé gynekologické operaci došlo s delším časovým odstupem čtyř měsíců ke kompletní dislokaci stentu do krevního oběhu, resp. dolní duté žíly a pravé srdeční síně. U pacientky byla zjištěna anomálie dolní duté žíly.
We report a case of extremely rare complication of insertion double J stent, which is a very frequent endoscopic procedure as a derivation of urine from upper urinary tract. Our case report involves rare event of total migration of double J stent from urinary tract to the inferior vena cava and right heart atrium due to anomaly of vena cava. Double J stent was inserted because of urine leakage after panhysterectomy for carcinoma of cervix.
- Klíčová slova
- dolní dutá žíla,
- MeSH
- endovaskulární výkony * využití MeSH
- hydronefróza MeSH
- hysterektomie metody škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- migrace cizích těles * radiografie MeSH
- močové píštěle * etiologie chirurgie MeSH
- perkutánní nefrostomie využití MeSH
- pooperační komplikace etiologie terapie MeSH
- srdeční síně * radiografie MeSH
- stenty * škodlivé účinky využití MeSH
- ureter * chirurgie zranění MeSH
- ureterostomie využití MeSH
- vena cava inferior * abnormality radiografie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
