The dissertation analyzed the results of organ-preserving treatment (partial cystectomy or TUR) of muscle-invasive bladder cancer (MIBC) with adjuvant chemoradiotherapy compared with radical cystectomy. Individualization of treatment tactics for patients with MIBC was considered as the ultimate goal, which allows a significant part of patients to undergo organ-sparing treatment while maintaining satisfactory survival rates and quality of life. The investigations were performed at the SI «Acad. O.F. Vosianov Institute of Urology of NAMS of Ukraine» on the basis of the Department of Oncourology in the KNP «Kyiv City Clinical Oncological Center» during 2008–2017. The work is based on the analysis of the results of treatment of 267 patients with MIBC, the surgical stage comprised radical cystectomy (RC), TUR or partial cystectomy with lymphadenectomy (LND). Final results in treatment groups were compared with RC with 63 radical cystectomies included.
The follow-up program carried out the verification of the diagnosis based on the results of pathomorphological follow-up, including the diagnosis of lymphovascular invasion (LVI) in the primary tumor, follow-up of the patient's life expectancy after radical and partial cystectomy. In all cases, the progression of the process was confirmed by the results of ultrasound examination (USE), computed or magnetic resonance tomography (CT and MRI), all patients underwent transurethral resection (TUR) and biopsy of tumors.
The general condition of patients before treatment was assessed on ECOG scale: 0 points – 236 (88,40 %), 1 point – 31 (11,60 %) ailments. The size of the primary lesion was 15–60 (in the middle – 36,00 ± 12,50) mm.
After the end of organ-preserving complex treatment, patients were examined in accordance with the recommendations of the EAU and NCCN – the assessment of the disease status was carried out at least 3 times a year, the scope of examinations during the monitoring visit was determined individually (the maximum scope of research included: cytological examination of urine, general clinical tests, CT/MRI, ultrasound, cystoscopy, repeated TUR – revisions with/without biopsy, PET CT, biopsies of distant metastases under ultrasound/MRI control).
Statistical analysis of the data was carried out according to the Kaplan-Meier method.
In the dissertation work, for the first time, on significant clinical material, the survival rates (overall, cancer-specific and recurrence-free), features of recurrence and the level of quality of life in patients with MIBC after organ-preserving complex treatment were traced.
A comparative analysis of the quality of life of patients with MIBC after organ-preserving complex treatment and RC was conducted.
An optimized algorithm for organ-preserving treatment of patients with MIBC has been developed. It has also been established that the appointment of adjuvant polychemotherapy and radiation therapy after organ-preserving treatment of MIBC increases life expectancy.
A higher level of quality of life after organ-sparing complex treatment for MIBC compared to radical cystectomy has been proven.
