Background/Objectives:Optimal selection for perioperative therapy in urothelial carcinoma (UC) remains uncertain. We evaluated the efficacy of neoadjuvant and/or adjuvant chemotherapy (NAC/AC) for patients with bladder cancer (BC) and upper tract UC (UTUC), examined the role of lymphovascular invasion (LVI), and considered the implications for adjuvant nivolumab.Methods:We retrospectively analyzed consecutive patients who underwent radical cystectomy or radical nephroureterectomy at a single center (July 1998–April 2021; observation to 31 March 2025). After exclusions, 252 BC and 153 UTUC patients were included. Endpoints were cancer-specific survival, progression-free survival (PFS; BC), non-urinary-tract recurrence-free survival (NUTRFS; UTUC), and overall survival (OS). Survival was estimated by Kaplan–Meier analysis and compared by log-rank tests.Results:For BC, AC did not improve the PFS or OS in the overall pT ≥ 2 population, whereas node-positive (pN+) disease derived significant benefits in both endpoints among NAC-naïve patients (PFS and OS,p= 0.002 andp= 0.008). For UTUC, AC conferred no advantage in NUTRFS or OS for the overall pT ≥ 2 population. However, NUTRFS benefits emerged in the pN+ subset (p= 0.049), although the OS was not improved. Among NAC-treated BC, the outcomes were poorest for ≥ypT3 and ypN+, whereas ypT ≤ 2 fared better. LVI was associated with adverse outcomes and was borderline higher in pN+ versus pT ≥ 2/pN− for BC (p= 0.056) and significantly higher for UTUC (p= 0.012).Conclusions:In this retrospective, single-center cohort, our exploratory analyses suggest that perioperative benefit is largely node-dependent, supporting prioritizing systemic therapy for pN+ disease and cautioning against routine AC for pT2/ypT2 without nodal involvement. After NAC, adjuvant therapy appeared most justified for ≥ypT3/ypN+. Prospective biomarker-integrated validation is warranted and, given the small and underpowered subgroups and the potential for selection and immortal time biases, these observations should be interpreted as hypothesis-generating rather than causal.
背景/目的：尿路上皮癌（UC）围手术期治疗的最佳选择仍不明确。本研究评估了新辅助和/或辅助化疗（NAC/AC）对膀胱癌（BC）和上尿路尿路上皮癌（UTUC）患者的疗效，探讨了淋巴血管侵犯（LVI）的作用，并考虑了其对辅助纳武利尤单抗治疗的启示。 方法：我们回顾性分析了单中心连续接受根治性膀胱切除术或根治性肾输尿管切除术的患者（1998年7月至2021年4月；随访至2025年3月31日）。排除后，共纳入252例BC患者和153例UTUC患者。终点指标包括癌症特异性生存期、无进展生存期（PFS；BC）、非尿路无复发生存期（NUTRFS；UTUC）和总生存期（OS）。采用Kaplan-Meier法估计生存率，并用对数秩检验进行比较。 结果：对于BC，在总体pT ≥ 2人群中，AC并未改善PFS或OS；而在未接受NAC的患者中，淋巴结阳性（pN+）疾病在这两个终点上均显示出显著获益（PFS和OS，p=0.002和p=0.008）。对于UTUC，AC在总体pT ≥ 2人群中未带来NUTRFS或OS优势。然而，在pN+亚组中观察到NUTRFS获益（p=0.049），但OS未改善。在接受NAC治疗的BC患者中，≥ypT3和ypN+患者的预后最差，而ypT ≤ 2患者预后较好。LVI与不良预后相关；在BC中，pN+患者的LVI发生率较pT ≥ 2/pN−患者呈临界性升高（p=0.056），在UTUC中则显著升高（p=0.012）。 结论：在这项回顾性单中心队列研究中，我们的探索性分析表明围手术期获益主要取决于淋巴结状态，支持对pN+疾病优先考虑全身治疗，并提示对于无淋巴结受累的pT2/ypT2患者应谨慎常规使用AC。在NAC治疗后，辅助治疗对于≥ypT3/ypN+患者似乎最具合理性。有必要进行前瞻性生物标志物整合验证；鉴于亚组样本量小、统计效能不足，以及存在选择和永生时间偏倚的可能性，这些观察结果应被视为假设生成而非因果结论。
肿瘤(癌症)患者之家