Objectives: To investigate neoadjuvant chemotherapy (NAC) eligibility, utilization, and survival outcomes for muscle-invasive bladder cancer patients undergoing radical cystectomy (RC) in a Finnish population. Materials and Methods: Data from the Finnish National Cystectomy Database (2005–2017) was combined with Finnish Cancer Registry survival data. NAC utilization rates were reported, and downstaging rates were calculated based on final pathological staging. Logistic regression analyzed NAC usage and complete response (CR) predictors. Results: Since 2011, 29% of 1157 patients received NAC. Its usage remained consistent, and the number of eligible patients not receiving NAC decreased during the study period. Among NAC patients, pathology T-category was pT0 (34%), pT1-Ta-Tis (16%), pT2 (23%), pT3 (20%), and pT4 (7%) tumors, with pN0 in 82%. In the RC + NAC group, the 5-year overall survival (OS) rates were 89% for patients with no residual disease (pT0N0), 82% for those with organ-confined residual disease (pT1, Tis, Ta, T2/N0), and 49% for patients with non-organ-confined residual disease (pT3+/N+). The corresponding cancer-specific survival (CSS) rates were 93%, 86%, and 57%, respectively. Patients with organ-confined residual disease after NAC had survival outcomes comparable to those who underwent RC alone. Higher age; odds ratio (OR) 0.93, [95% Confidence Interval (CI): 0.90–0.95] and Charlson Co-morbidity Index–score [OR 0.88 (0.79–0.98)] reduced the likelihood of receiving NAC, while a smaller center size increased the probability [OR 1.82 (1.02–3.28)]. More treatment cycles [OR 0.70, (95% CI: 0.51–0.93)] and a favorable GFR [OR 0.38 (0.16–0.88)] were associated with achieving CR. Conclusion: We report that NAC is well-utilized across Finland, with CR rates comparable to recent trials. Additionally, our survival rates are reasonable, and even with organ-confined residual disease after NAC, survival outcomes are similar to those who underwent RC alone.
目的：探讨芬兰人群中接受根治性膀胱切除术的肌层浸润性膀胱癌患者新辅助化疗的适用性、应用情况及生存结局。材料与方法：结合芬兰国家膀胱癌数据库（2005-2017年）与芬兰癌症登记处的生存数据，报告新辅助化疗使用率，并根据最终病理分期计算降期率。采用逻辑回归分析新辅助化疗使用情况及完全缓解的预测因素。结果：自2011年以来，1157例患者中有29%接受了新辅助化疗。其使用率保持稳定，研究期间符合条件但未接受新辅助化疗的患者数量有所减少。在接受新辅助化疗的患者中，病理T分期为pT0（34%）、pT1-Ta-Tis（16%）、pT2（23%）、pT3（20%）和pT4（7%），其中82%为pN0。在根治性膀胱切除联合新辅助化疗组中，无残留病灶（pT0N0）患者的5年总生存率为89%，器官局限残留病灶（pT1、Tis、Ta、T2/N0）患者为82%，非器官局限残留病灶（pT3+/N+）患者为49%；相应的癌症特异性生存率分别为93%、86%和57%。新辅助化疗后存在器官局限残留病灶患者的生存结局与仅接受根治性膀胱切除术者相当。高龄[比值比0.93，95%置信区间：0.90–0.95]及较高查尔森合并症指数评分[比值比0.88（0.79–0.98）]会降低接受新辅助化疗的可能性，而较小规模的医疗中心则会增加其概率[比值比1.82（1.02–3.28）]。更多治疗周期[比值比0.70（95%置信区间：0.51–0.93）]与较好的肾小球滤过率[比值比0.38（0.16–0.88）]与实现完全缓解相关。结论：本研究表明新辅助化疗在芬兰得到广泛应用，其完全缓解率与近期临床试验结果相当。此外，患者的生存率处于合理水平，即使新辅助化疗后存在器官局限残留病灶，其生存结局仍与仅接受根治性膀胱切除术者相似。
肿瘤(癌症)患者之家