Clinical Efficacy Of CTURBT Combined With Systemic Chemotherapy For Muscle-invasive Bladder Cancer （T₂N₀M₀）

Objective:By comparing the prognosis and quality of life of patients with stage T₂N₀M₀high-grade urothelial carcinoma treated by completing transurethral resection of bladder tumor（cTURBT）combined with systemic chemotherapy versus traditional radical cystectomy treatment,to evaluate the clinical efficacy of bladder preservation therapy.Methods:In this study,a total of 70 patients with stage T₂N₀M₀high-grade urothelial carcinoma were retrospectively selected from the China-Japan Union Hospital of Jilin University from January 2019 to January 2022,according to inclusion and exclusion criteria.The patients were divided into two groups according to different treatment regiments,29 patients with cTURBT combined with GC regimen systemic chemotherapy were included in the comprehensive treatment group,and 41 patients with radical cystectomy were included in the radical treatment group.Preoperative general data,perioperative data and postoperative follow-up data of the two groups of patients were collected and statistically analyzed.Results:1.There were no statistically significant differences in preoperative general data between the two groups in the terms of age,gender,smoking history,preoperative hematuria,tumor number,tumor size and underlying diseases between the two groups（P>0.05）.2.Patients in the comprehensive treatment group were better than those in the radical treatment group in terms of operation time,intraoperative blood loss,postoperative blood transfusion rate,hospital stay,treatment cost,perioperative complications,etc.In the comprehensive treatment group,45 cases（88.24%）of mild adverse reactions（Grade 1-2）and 6 cases（11.76%）of severe adverse reactions（Grade 3-4）were caused by systemic chemotherapy.The chemotherapy related adverse reactions were mainly mild and improved after symptomatic treatment.The fourth edition of function assessment of cancer therapy-bladder cancer form（FACT-BL）was used to evaluate the postoperative quality of life of the two groups.The physical status,social and family status,emotional status,functional status and bladder related indicators in the comprehensive treatment group were significantly better than those in the radical treatment group（P<0.05）.3.All patients were followed up until December 2022.Patients in the comprehensive treatment group were followed up for 11-46 months,with an average follow-up time of 26.9 months.Patients in the radical treatment group were followed up for 10-44 months,with an average follow-up time of 26.1 months.There was no statistical differences in 1-year and 2-year recurrence rate and cancer mortality between two groups（P>0.05）.The success rate of bladder retention without disease progression in the comprehensive treatment group was 75.86%,and the CSS,OS and RFS in the comprehensive treatment group were 95.0%,80.3%and 72.2%,respectively.Kaplan-Meier method was used to describe the survival curve of RFS,CSS and OS in the two groups.Log Rank method was used to test the difference between the two groups,and there was no statistical significance（P>0.05）.Conclusions:1.Compared with radical cystectomy,cTURBT combined with systemic chemotherapy with GC regimen has a positive perioperative outcome,higher postoperative quality of life,and acceptable toxic effects.2.In selected patients with stage T₂N₀M₀muscular invasive bladder cancer,a higher success rate of bladder preservation was achieved with combined bladder-sparing therapy,with no difference in tumor control compared with radical surgery.