Trimodal Therapy for T3 Muscle-Invasive Bladder Cancer：a retrospective case series study

Abstract

BACKGROUND: Bladder sparing therapy not only preserves bladder function and improves quality of life for patients, but also achieves survival rates similar to radical cystectomy. OBJECTIVE: To investigate the therapy of T3 muscle invasive bladder cancer (MIBC) by transurethral photo-selective vaporization of bladder tumors (PVBT) combined with radiotherapy and chemotherapy, and to accumulate evidence for further research. METHODS: This a retrospective case series study. The T3 bladder cancer patients received PVBT combined with preoperative neoadjuvant radiotherapy and postoperative adjuvant chemo-radiotherapy were selected from January 2018 to December 2020. The tumor changes after neoadjuvant radiotherapy, adverse reactions of chemo-radiotherapy, and the incidence of complications were followed up by outpatient and telephone. The expression of CK20, FGFR3, PLEKHG4B, CK6, and Desmin was detected by immunohistochemistry, and the factors affecting the recurrence and survival of bladder cancer were statistically analyzed. RESULTS: A total of 48 patients completed PVBT were included. The maximum diameter of the tumor was 0 ~ 6.0 cm after neoadjuvant radiotherapy, with an average of 2.1 cm, which was smaller than that pre-radiotherapy (P< 0.05). The number of tumors decreased by 11 cases (47.83%), the clinical stage of tumors decreased by 13 cases (27.08%) and 42 cases (87.50%) had varying degrees of radiation or chemotherapy toxicity. During the follow-up period, 22 patients (45.83%) experienced recurrence, and 10 patients died of distant organ metastasis or cachexia. Multivariate Cox regression analysis showed that tumor diversity and FGFR3 gene affect the recurrence of bladder tumor, while age and tumor diameter affect the survival rate of bladder tumors. CONCLUSIONS: This study is the small-scale case series study ofT3 bladder cancer patients received PVBT combined with preoperative neoadjuvant radiotherapy and postoperative adjuvant chemo-radiotherapy, which is an effective method to treat T3 MIBC. Meanwhile, monitoring FGFR3 in patients with MIBC is very important for evaluating prognosis.