Prognostic Effect Of Combined Bladder-sparing Therapy On Localized Muscle-invasive Bladder Cancer

Objective: To evaluate the efficacy and feasibility of bladder sparing surgery followed by adjuvant chemotherapy for patients with localized muscle-invasive bladder cancer compared to radical surgery.Methods: We identified 29 patients diagnosed as primary T2-T3N0M0 urothelial carcinoma of the bladder from July 2012 to March 2018 at our institution.Initial surgery was performed in all patients by the same surgeon.17 patients underwent bladder sparing surgery followed by adjuvant chemotherapy,and 12 patients underwent radical cystectomy with bilateral pelvic lymph nodes dissection.Bladder sparing surgeries referred to complete transurethral resection of bladder tumor performed in seven patients and simple partial cystectomy performed in ten patients.Gemcitabine(1600mg day 1,8)and cisplatin(120mg day 1)regimens were applied as adjuvant chemotherapy and at least two cycles were completed.Patient characteristics were reported.The survival outcome was estimated by Kaplan-Meier method and compared with log rank test.Results: In baseline parameters,tumor location of bladder sparing group was more likely to be at a local area inside bladder compared with that in radical group(82.4% vs 33.3%,p = 0.018).The median follow-up was similar between bladder sparing group and radical group(38 months,IQR 21-48 vs 21 months,IQR 13-44,p = 0.264).In the bladder sparing group,the cycles of adjuvant chemotherapy were 2-3 in 5 patients and 4-6 in 12 patients without anyone withdrawing because of toxicity.Six patients(35.3%)of bladder sparing group had intravesical urothelial carcinoma recurrence,in which four were p Ta or p T1 stage treated with TURBT and two were p T2 a or p T4 a stage treated with salvage radical surgery.Finally,15 patients(88.2%)who initially underwent bladder sparing therapy maintained an intact bladder during the follow-up.No difference was noted for initial cancer-specific survival and metastasis-free survival between patients treated with bladder sparing and radical therapy.Conclusion: Bladder sparing surgery followed by adjuvant chemotherapy resulted in a comparatively satisfactory outcome in selected muscle-invasive bladder cancer compared to radical surgery.Among those selected patients who refused or were unfit to radical surgery,it provided another potential treatment option.However,patients who undergo bladder sparing therapy remain at risk for intravesical recurrence and extravesical metastasis.Ideal candidates could be those who had T2-T3 stage disease without extravesical metastasis and tumor(s)located at a local area inside bladder.