Yaşlı kas invaziv mesane kanseri hastalarında mesane koruyucu trimodal tedavi: tek merkez gerçek yaşam deneyimi

Abstract

Amaç: Bu çalışmada, erken evre kas invaziv mesane kanseri (MIBC) tanısı almış ve trimodal tedavi (TMT) uygulanmış ileri yaşlı hasta grubunda, gerçek yaşam verileri kullanılarak sağkalım sonuçları ile prognostik belirteçlerin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Bu retrospektif analizde, yaş ortalaması 70 olan ve evre T2N0–T2N1 MIBC tanısı alarak TMT (maksimal transüretral rezeksiyon, kemoterapi ve radyoterapi) uygulanmış 23 hasta değerlendirilmiştir. Genel sağkalım (OS) ve progresyonsuz sağkalım (PFS) Kaplan-Meier yöntemiyle hesaplanmış; prognostik faktörler çok değişkenli Cox regresyon analiziyle incelenmiştir. Ayrıca, PLR ve NLR gibi sistemik inflamatuar belirteçlerin prognostik rolü de değerlendirilmiştir. Bulgular: Ortanca OS süresi 22 ay (%95 GA: 12,5–31,5), ortanca PFS süresi ise 19 ay (%95 GA: 14,5–47,4) olarak hesaplanmıştır. Platin bazlı kemoterapi uygulanan hastalarda OS anlamlı şekilde daha uzun bulunmuştur (HR: 0,041; p = 0,015). Yüksek PLR ve ileri N evresi OS ile negatif yönde ilişkili bulunmuştur. PFS açısından anlamlı bir değişken saptanmamış olmakla birlikte, T evresindeki artış sağkalımda azalma eğilimi göstermiştir. Radyoterapi dozunun sağkalım üzerinde anlamlı bir etkisi gözlenmemiştir. Sonuç: Bu çalışma, komorbiditesi yüksek yaşlı MIBC hastalarında TMT’nin etkin ve tolere edilebilir bir tedavi seçeneği olduğunu göstermektedir. Platin temelli rejimlerin sağkalım avantajı sağladığı; PLR ve nodal evrenin ise potansiyel prognostik belirteçler olarak öne çıktığı belirlenmiştir. Kabul edilebilir toksisite oranları ve sağkalım verileri göz önünde bulundurulduğunda, TMT yaşlı bireyler için mesane koruyucu umut verici bir alternatif olarak değerlendirilmelidir.

Keywords

• kas invaziv mesane tümörü
• trimodal tedavi
• yaşlı hasta

Ethical Statement

The study protocol was approved by the Ethics Committee of the University of Health Sciences, Gülhane Faculty of Medicine (Approval No: 2025/192, dated April 8, 2025).

Bladder-sparing trimodal therapy in elderly patients with muscle-invasive bladder cancer: a real-world single-center experience

Abstract

Aim: This study aimed to evaluate survival outcomes and potential prognostic indicators in a real-world cohort of elderly patients diagnosed with early-stage muscle-invasive bladder cancer (MIBC) who underwent trimodal therapy (TMT). Material and Methods: This retrospective study included 23 patients with a mean age of 70 years diagnosed with stage T2N0–T2N1 MIBC and treated with TMT, which comprised maximal transurethral resection, chemotherapy, and radiotherapy. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method, and the impact of clinical and laboratory variables on survival was assessed through multivariable Cox regression analysis. Inflammatory biomarkers such as the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) were also evaluated for their prognostic significance. Results: The median OS was 22 months (95% CI: 12.5–31.5), and the median PFS was 19 months (95% CI: 14.5–47.4). Patients receiving platinum-based chemotherapy had significantly improved OS (HR: 0.041; p = 0.015). Higher platelet-to-lymphocyte ratio (PLR) and advanced nodal stage (N stage) were negatively associated with OS. Although no factor was significantly associated with PFS, a trend toward decreased survival was observed with increasing T stage. Radiotherapy dose did not have a significant impact on survival outcomes. Conclusion: This study highlights the efficacy and tolerability of TMT in elderly, comorbid patients with early-stage MIBC who are candidates for bladder preservation. Platinum-based regimens appear to confer a survival advantage, while PLR and nodal stage may serve as practical prognostic markers. Given the acceptable survival outcomes and favorable toxicity profile, TMT should be considered a promising bladder-sparing option for appropriately selected elderly patients.

Keywords

• urinary bladder neoplasms
• combined modality therapy
• aged

Ethical Statement

The study protocol was approved by the Ethics Committee of the University of Health Sciences, Gülhane Faculty of Medicine (Approval No: 2025/192, dated April 8, 2025).

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