放射治疗（RT）是肌层浸润性膀胱癌（MIBC）患者的激进膀胱切除术（RC）替代选择。研究分析RT后MIBC患者完全缓解（CR）和生存预测因子。本研究是一项回顾性多中心研究，纳入2002年至2018年间接受治愈性RT的864例非转移性MIBC患者。采用回归模型探讨与CR、癌特异性生存（CSS）和总生存率（OS）相关的预测因素。患者中位年龄为77岁，中位随访时间为34个月。疾病分期为675例（78％）的cT2和766例（89％）的cN0。147例（17％）接受新辅助化疗（NAC），542例（63％）接受同时化疗。592例（78％）患者经历了CR。 cT3-4分期（比值比[OR] 0.43，95％置信区间[CI] 0.29-0.63; p < 0.001）和肾积水（OR 0.50，95％ CI 0.34-0.74；p = 0.001）与较低的CR显著相关。5年生存率分别为CSS的63％和OS的49％。较高的cT分期（HR 1.93，95％ CI 1.46-2.56；p < 0.001），原位癌（HR 2.10，95％ CI 1.25-3.53; p = 0.005），肾积水（HR 2.36，95％ CI 1.79-3.10；p < 0.001），NAC使用（HR 0.66，95％ CI 0.46-0.95；p = 0.025）和整个盆腔RT（HR 0.66，95％ CI 0.51-0.86；p = 0.002）与CSS独立相关；年龄较大（HR 1.03，95％ CI 1.01-1.05；p = 0.001），状态较劣（HR 1.73，95％ CI 1.34-2.22；p < 0.001），肾积水（HR 1.50，95％ CI 1.17-1.91；p = 0.001），NAC使用（HR 0.69，95％ CI 0.49-0.97；p = 0.033），整个盆腔RT（HR 0.64，95％ CI 0.51-0.80；p < 0.001）和手术不适宜（HR 1.42，95％ CI 1.12-1.80；p = 0.004）与OS相关。本研究受不同治疗方案异质性的限制。对于选择治愈性保留膀胱的患者而言，MIBC的RT可在大多数患者中达到CR。NAC和整个盆腔RT的效益需要进一步进行前瞻性试验验证。我们调查了接受治愈性放疗作为替代手术切除膀胱治疗肌层浸润性膀胱癌患者的预后情况。化疗在放疗前和全盆放疗（膀胱及盆腔淋巴结）的效益需要进一步研究。版权所有©2023欧洲泌尿学协会。Elsevier B.V.出版，版权所有。

Radiation therapy (RT) is an alternative to radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC).To analyze predictors of complete response (CR) and survival after RT for MIBC.This was a multicenter retrospective study of 864 patients with nonmetastatic MIBC who underwent curative-intent RT from 2002 to 2018.Regression models were used to explore prognostic factors associated with CR, cancer-specific survival (CSS), and overall survival (OS).The median patient age was 77 yr and median follow-up was 34 mo. Disease stage was cT2 in 675 patients (78%) and cN0 in 766 (89%). Neoadjuvant chemotherapy (NAC) was given to 147 patients (17%) and concurrent chemotherapy to 542 (63%). A CR was experienced by 592 patients (78%). cT3-4 stage (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.29-0.63; p < 0.001) and hydronephrosis (OR 0.50, 95% CI 034-0.74; p = 0.001) were significantly associated with lower CR. The 5-yr survival rates were 63% for CSS and 49% for OS. Higher cT stage (HR 1.93, 95% CI 1.46-2.56; p < 0.001), carcinoma in situ (HR 2.10, 95% CI 1.25-3.53; p = 0.005), hydronephrosis (HR 2.36, 95% CI 1.79-3.10; p < 0.001), NAC use (HR 0.66, 95% CI 0.46-0.95; p = 0.025), and whole-pelvis RT (HR 0.66, 95% CI 0.51-0.86; p = 0.002) were independently associated with CSS; advanced age (HR 1.03, 95% CI 1.01-1.05; p = 0.001), worse performance status (HR 1.73, 95% CI 1.34-2.22; p < 0.001), hydronephrosis (HR 1.50, 95% CI 1.17-1.91; p = 0.001), NAC use (HR 0.69, 95% CI 0.49-0.97; p = 0.033), whole-pelvis RT (HR 0.64, 95% CI 0.51-0.80; p < 0.001), and being surgically unfit (HR 1.42, 95% CI 1.12-1.80; p = 0.004) were associated with OS. The study is limited by the heterogeneity of different treatment protocols.RT for MIBC yields a CR in most patients who elect for curative-intent bladder preservation. The benefit of NAC and whole-pelvis RT require prospective trial validation.We investigated outcomes for patients with muscle-invasive bladder cancer treated with curative-intent radiation therapy as an alternative to surgical removal of the bladder. The benefit of chemotherapy before radiotherapy and whole-pelvis radiation (bladder plus the pelvis lymph nodes) needs further study.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.