576
2535580226014562122179
Ces37297936014570127174
Urol39287936014578115180208
2023;41617936014562121178238260
27(3):44467936014562119147205234256
251-26147287936014561121176207262320374
PŮVODNÍ4031207016974172259362464566608
PRÁCE4686207016974156253339415
evaluated624898013153102152174231280312363423
the107389801313492145
intention‑to‑treat124489801312380112163221253275332391424458514549582614665713745
population,2015898013161120180238260309341363421479497
even2538898013153102154212
the624104801313492145
patients8001048013161110143165217275307349
who11791048013180138197
did1406104801316082141
not15781048013159117149
undergo17581048013158116176228260318376
surgical2165104801314197128186208256306328
treat‑2524104801313466117165197226
ment6241198013189141198229
were8721198013179130161211
included.1103119801312279126148204262314373391
We15141198013189138
assessed1671119801315088127179219258310369
five‑year2059119801312753101152186233284331361
cancer­2440119801314897154201251282310
‑specific624134801313373132186236258284310359
survival1009134801314198129182205254304326
(CSS)1361134801313089141189217
using1605134801315898119176236
Kaplan‑Meier18671348013155106166189237295328415468490542574
curves24671348013149107138191243283
and6241498013151110171
compared8281498013150108199260311344397458
survival1320149801314199132186210260311334
within16881498013180104138198220279
subgroups20001498013142100161223255313373434475
using25081498013160100122181242
the624164801313492145
log‑rank790164801312381142175208257315361
test.1172164801313484125159178
Response13711648013156109149208267326365418
to1810164801313490
chemotherapy19211648013149107160249307340398451482532592639
was25811648013179129169
defined6241798013160113138165223276336
as987179801314989
complete11031798013149105194254277330363414
(pCR1544179801312989153206
–17751798013155
ypT0N0),18561798013149110153205275329356372
partial22541798013161111142179201249272
(pPR2552179801312990145198
≤6241948013167
ypT1N0)7251948013149112158210275330359
or1117194801316094
no12441948013161121
response1399194801313386128189250311352407
(non‑R;1839194801313087147208242301321
≥ypT2N0–3).21941948013167114177223279348404464514540556
The6242098013151111164
influence808209801312381106133190243300349400
of1228209801315987
clinical133520980131497293150172220270292
and16482098013149107166
histopathological1835209801315980119154210270320352410468491549609631679729751
pa‑26062098013161111144
rameters624224801313384175230264316349391
on10482248013160119
progression‑free1201224801316295153214247299341382404463523557587621674729
survival1964224801314199131186209260311334
(PFS)2331224801313086135184213
was25772248013181132173
evaluated6242398013153101150171227275307357416
using1059239801315897118174233
the1311239801313491143
Cox14732398013162118162
regression1655239801313283142172223263302322379437
model.21112398013189147206258280298
Median24282398013185137197218265322
follow‑up624254801312986109131189267300359419
was10672548013179129169
4312602548013154103
months13872548013190148207238296336
(IQR1747254801312951124179
16–87).19502548013154101158213263292307
Results:7742692013765121167229257296342369
The11572698013151109159
average1333269801315095145174222279330
age16792698013150107158
of1853269801315985
the1955269801313389140
patients21122698013160108138158208264294333
was24622698013179126164
6426432698013153106
years,624284801314899145175214231
men8742848013190141198
and10912848013150106164
women12732848013180136224275331
comprised16232848013149104192249280301338390448
76%20902848013154100178
and22872848013150106163
24%24692848013154100177
of2665284801315885
the624299801313388138
cohort,7782998013148101156211241275291
respectively.1085299801313280118174224271304324370419439484495
The15952998013151107157
extent1768299801315297131179233262
of2046299801315883
the2145299801313388138
primary2299299801316089109194240268317
tu‑2632299801313388118
mor6243148013189145174
was8143148013179126163
cT2993314801314989140
in1149314801312378
3912433148013153100
and13603148013149104161
cT3–41537314801314888140193246
in1799314801312378
611893314801315395
cases.2005314801314895132183220237
The22593148013150107158
median24333148013189139197216262317
number6243298013158113199256307336
of977329801315784
lymph1077329801312368156213269
nodes13623298013158114172222260
removed1638329801313281167223269318376
during20303298013159113142163218274
procedure2321329801316089143190239296351380429
was6243448013181131170
248243448013155102
(IQR957344801312950124179
19;29).11663448013155100117170222247262
Five‑year1458344801315272121173207255307355386
CSS18743448013164115164
reached2068344801313384132181238291352
84%24503448013155110189
in2669344801312381
cT2–4N0624359801314990143193247315367
and10153598013150106163
52%12023598013154102180
in1406359801312379
cT2–4N1–3.1508359801315091143193248315361409456472
Five‑year2003359801315171119169202248299345375
CSS24013598013163113160
was25853598013179127165
not6243748013159117148
different801374801316181109139190220271328358
for1189374801312985116
cN113343748013150118164
versus15273748013150101132171227265
cN2–318213748013150118168219266
(53%2117374801312979127205
and23523748013150107165
50%,25473748013154104185203
respectively).624389801313384123182235284319340389440462509535549
We12023898013192141
recorded1373389801313383132188219276328388
a17913898013150
response1871389801313384123182241299337390
to2290389801313590
chemo‑24103898013149107159248306340
therapy624404801313490142171220278323
(cCR+pCR)964404801312973134186247304366418444
in1426404801312378
34/4915224048013153105141186235
(69%)1774404801312978127207231
patients20224048013161109139160211267297337
with23764048013180100132189
cN025824048013149116168
and6244198013151109168
in822419801312481
24/519344198013154102139190236
(47%)1200419801313080128208232
cN1–3.14624198013150119167216264281
Achieving17744198013165112170191244292314372431
response2236419801313384124183242301340393
to2659419801313591
chemotherapy6244348013150107159248305337394446477526585631
improved12844348013124112171202258305356416
5-year1729434801315486133185232262
CSS20214348013163114162
in2212434801312380
both23224348013161120151208
sub‑2560434801314197156190
groups,624449801316089143199256294311
in952449801312278
cN010464498013149116168
patients12304498013161108138159209265295334
93%15814498013153100177
versus17744498013150100129168222259
60%20504498013153105184
(p=0.001),2251449801312987152206222274326372390404
in2672449801312278
cN1–36244648013149115161208254
85%8954648013154103178
versus1090464801314999128167221259
27%13654648013154101179
(p<0.001).1560464801312987149199215266319364383396
In1972464801312379
the2068464801313389140
entire22254648013153109139159188237
group,2479464801315989143199256271
the624479801313491143
30-day7964798013154105139200247292
and11174798013150107165
90-day13114798013154107142202250295
mortality16354798013190147178214262283303335385
reached2049479801313283129177233285344
0%24224798013154134
and25854798013150107165
3%,6244948013154131148
respectively.800494801313282121178231279313333381431452499510
In1338494801312379
multivariate14454948013190145166197218265314343364411441491
analysis,19634948013150106153174220259279316333
significant2324494801314160118174194218245292340396426
predictors624509801316293144203224272307362393434
of1087509801316087
progression‑free1204509801316192148208238289329368388445503536564596647700
survival1933509801314298128180202251300321
were22845098013180132162213
initial2527509801312380101133154202223
nodal6245248013159116174221242
involvement887524801312379124180201249299386438494524
(HR1432524801312995148
2.92;1601524801315470119167183
p=0.007)18055248013161126181197249302350377
and22035248013150106164
failure238852480131287798118173203253
to2662524801313488
respond624539801313282121178236293351
to995539801313489
NAC11055398013170131189
(HR1314539801313096148
6.56;1483539801315471123174189
p≤0.001)16935398013161123173189241294340359
Conclusion:7745542013765127192242273337385416479544572
In1367554801312381
patients14695548013161111143165218275307349
with18395548013179102135193
invasive2054554801312380127177217238287339
bladder2414554801316184133192252305336
cancer624569801314999156205255287
who9315698013179138196
are1147569801315081133
treated1300569801313466117165197248308
with16285698013180102135193
neoadjuvant18425698013158111170220279301358408457515547
chemo‑24095698013149106159248306341
therapy624584801313492145177226286333
followed981584801312986109131189267319380
by13845848013161108
radical1516584801313383142164212262284
cystectomy,18245848013149100140175226275312368457503516
excellent23645848013154101148199222244296354386
oncological6245998013159119169226250309370393442493516
results1173599801313385126184207241284
can14905998013149100159
be16825998013162117
achieved18325998013151100159181235285338399
in2264599801312482
clinically238059980131497294153175225275298321370
localized624614801312381131181203224268320380
disease.1031614801315981120173221261314331
Even1389614801315199151209
in1625614801312380
the1732614801313492145
case1904614801314999138191
of2122614801315987
clinical223661480131497192150172220270292
lym‑2555614801312371161195
phadenopathy,6246298013161119168228280338397457507539597643656
up13106298013158118
to1458629801313489
half15776298013159108130158
of1765629801315987
patients18826298013160110142165217275307348
survive2260629801314198129182205254306
five2595629801312754103155
years.6246448013148100148179220239
Achieving8836448013165112169191243292314372431
a13346448013150
response1404644801313384124183242300339392
to1816644801313490
chemotherapy19266448013149107160248307339397450481530590637
and25836448013150107167
the624659801313492145
absence8006598013150110150203261309360
of1192659801315886
lymphadenopathy1310659801312371161221279328388441498557617667699757803
at2144659801315083
the2258659801313492145
time2434659801313456145198
of2663659801315987
diagnosis624674801316082130189247305345367406
reduce1054674801313284144201250300
the1379674801313492145
risk154867480131325594139
of1711674801315887
recurrence.1822674801313284133191222254306364412463480
KEY6257034014770134206
WORDS85870340147105189260345408
Chemotherapy,6247198013162119171258316347404456487536595641653
neoadjuvant12977198013158110168217276297353401450507538
therapy,1854719801313491143174223281328340
urinary2214719801315788110166214245296
blad‑2529719801316083130189221
der6247348013160113144
neoplasms.7927348013159112171231255303343431471490
………62476340147120240360
ÚVOD2978858018197183286388
V29761198013156
léčbě3068119801312378129190246
invazivních3350119801312382131183229254305366389439499
nádorů38841198013159110171231265325
močového42451198013190150202259309363423483
měchý‑47641198013190145196256304338
ře2976134801313388
nedošlo31011348013160116180241284309370
za3508134801314599
poslední36441348013162125168192248312373397
tři407813480131356994
dekády42091348013161117166220283335
k45811348013147
zásadním4665134801314599142195258319344436
změnám.29761498013144136191251302393414
Základním34251498013160112159185236297357380471
kamenem3932149801314799190245305360452
terapie4419149801313487120172234258313
zůstává47671498013145105146182234283335
nadále29761648013158108167217240293
radikální3292164801313282142165211262285343366
cystektomie36801648013149100141176228274312368458481534
zahrnující4236164801314495154186245302325348397419
rozsáhlou4678164801313289132175226284307366424
pánevní29761798013161112172226277337361
lymfadenektomii3369179801312473165194247308362422477524562620711735758
a41601798013150
perioperační42421798013161116149174233295351384435485545568
systé‑4843179801314191134170223259
mová29761948013190150200251
léčba.3257194801312478129190241262
I35491948013123
přes3602194801316194147189
kvalitně38211948013146100152176199234294348
provedený4199194801316194153202256318372432480
operační47081948013159121176209261311371394
výkon29762098013150103152210270
dochází32742098013160119170230280327351
u36522098013159
30–5037382098013154108168221274
%40392098013181
nemocných41482098013159114204264316375423472531
k47072098013146
relapsu4781209801313286110160221263321
onemocnění29762248013158117170259318368426479538560
kvůli3558224801314699158181203
přítomným3784224801316092115149206295354400490
mikrometastázám,42972248013189111157191248338391425475515551601646697786805
což29762398013149106150
je3150239801312377
argumentem3250239801315083142201291345404438490580
pro3854239801316094151
podání40292398013160121182233292315
systémové4367239801314192134170222312372421475
léčby4865239801312377128189237
s29762548013141
neoadjuvantním30392548013158112171222282305362412462521553612635723
záměrem.3785254801314495184238270322411431
Neoadjuvantní42382548013170123183233293316374424474532565623646
che‑49072548013148106160195
moterapie29762698013190150184237270321383407461
(NACH)34652698013129100164225295324
u38172698013159
pacientů39042698013161112163186240300333392
cT2–4aN04325269801314993149202260313384439
schop‑4793269801314191150210272309
ných29762848013161111162224
dostat32372848013162124168206259295
cisplatinu3570284801315075117181207260295320382443
zlepšuje4051284801314571128192236296322378
v44672848013151
absolutních45562848013151115159221247308345408432484546
číslech2976299801314972113136191242301
přežití3305299801316194147193217252276
o36082998013159
836942998013154
%37752998013181
(1,388429980131297891
2).400229980131548299
U31263148013168
pacientů32133148013160109156177228285316372
s36043148013140
lymfadenopatií3663314801312370159185235293344401458517566597618639
je4321314801312374
situace441431480131416194150198245295
obtížněj‑47283148013157116148169212269321342374
ší,297632980131416280
klinická308132980131467092149171219265315
doporučení34213298013159118178237269327376426484506
jsou3951329801312463121179
nedostatečná,41543298013159112172230270305355387438487545593612
i47903298013123
vzhle‑4837329801315097155177230265
dem29763448013159112200
k31963448013146
tomu,3262344801313489178234252
že3534344801314494
máme36483448013190138226279
dostupné39473448013159116156190247306364416
pouze43833448013160119176220271
retrospek‑4674344801313283115147203242301354399428
tivní2976359801313456105164186
studie,3186359801314175133192214267284
které3493359801314784135166218
ale3734359801315072125
nicméně3883359801315981129218271329382
téměř4289359801313485174227257
jednohlasně4570359801312376136194252311333382421479532
poukazují29763748013162123183230283329390413436
na34463748013160111
benefit35903748013163119179234260288322
multimodálního39463748013193152175210233324385447498521580603665726
přístupu.4705374801316396119160196256317377397
Ten29763898013153100160
je3170389801312479
vhodný32833898013151112173235295343
pro3660389801316296154
vybrané38483898013151105168202254314369
pacienty,42513898013162114165188242302335389403
kteří4688389801314886139171195
jsou4917389801312465125185
vhodnými29764048013150110170231290337429451
adepty34604048013151111165226260312
pro3805404801316194152
neoadjuvantní39904048013159113174225285308366416467526558618640
(indukční)4663404801313052110171229275323382404439
chemoterapii29764198013150109163254313346399431482543566588
založenou3597419801314597120179223275334394453
na40834198013160110
cisplatině4226419801315072112172196246279302360414
a46734198013151
konsoli‑47574198013147105165205265289311345
dační29764348013161112162222245
cystektomie32554348013150103145182234282320378471494549
se3838434801314297
provádí3969434801316295154204256318341
pouze43444348013162123183229283
u46614348013160
nemoc‑47554348013160115207268319347
ných,29764498013159105153211229
kde32384498013146105158
byla34284498013161109132181
vyloučena36414498013150102126184242291342400449
progrese4123449801316193150210242293334387
onemocnění45424498013159118171261319369427481539560
po29764648013161120
chemoterapii.31204648013149107160249307340391422472531554576594
Až31264798013163109
polovina32544798013159117139196243264320368
nemocných36414798013158109196253301358403449505
ale4165479801314970122
není43064798013158109166186
schopna4511479801314188144201260317364
pod‑48944798013160117176208
stoupit2976494801314278136197259282317
NACH33274948013172138199269
kvůli36304948013148103164187210
kontraindikacím38744948013147106167201234286309369430453501553604627719
a46274948013151
přibližně4712494801316396120182206229274335390
3029765098013153105
%31005098013181
nemocných32015098013158110198256305362407454511
neodpovídá37325098013158111169229287346393416474522
na42745098013158106
cisplatinu4400509801314970108167190237269291347404
(3).4823509801312979104119
Pro4961509801315585141
tyto2976524801313383119174
pacienty31695248013160108156176228284315365
jsou3552524801312461118175
nadějné37465248013158105163214235291343
výsledky4108524801314999139160211270314364
neoadjuvantní44915248013158110167216274295350398447503534590611
imunoterapie,29765398013123110167224281313363394444502524576592
která3588539801314682133164213
dosahuje38205398013160117156206263319341393
kompletní42335398013146102190249272324356414435
odpovědi46885398013158117176235282333392414
u29765548013159
31–4630675548013154100150206262
%33615548013181
pacientů34755548013161111160182235293325383
cT24aN0,3890554801314992147195246315369387
což43095548013149106149
je4490554801312476
srovnatelné4599554801314172129177237286318369392450503
s29765698013141
chemoterapií.30505698013150108162252311344396428479539562584603
Velké36855698013157107130176228
úsilí3946569801315999120143165
je4143569801312478
směrováno42535698013142131185217274323374432491
také4777569801313485131183
na49935698013160109
vývoj2976584801314999150206227
prediktivních3221584801316090140198219263298319366424444490546
genomických37865848013158109165222309329376420469515571
biomarkerů,4375584801316081137224271301346396426482499
které4892584801314681130160210
by29765998013161107
umožnily31045998013158146204247305326348396
lepší3520599801312376135175196
selekci3736599801314194116169214261283
nemocných40395998013158111200258307365410458515
k45745998013147
systémové4641599801314190130164215304362410461
léčbě2976614801312376125185239
(4).3239614801312978104119
Cílem3126629801316282106157244
studie3389629801314074130188209260
bylo36686298013159105127184
zhodnotit38716298013143100157216272329360381413
dlouhodobé4303629801315980137193249306365421480532
onko‑48546298013158115159214248
logické2976644801312381142163212257309
výsledky33086448013150102142164217277323374
u37066448013158
vybrané37886448013149101162194244302355
skupiny4166644801314186144204226284330
pacientů45196448013161111160181234292324381
s49246448013141
in‑4988644801312381114
vazivním29766598013150100144167216275297385
nádorem33896598013159107167225257308397
močového38146598013190148197253301353411470
měchýře,43116598013190143192250296328380396
kteří4735659801314683134165187
byli49496598013161108132153
schopni2976674801314190147206266325346
podstoupit33536748013161120180220254310368428450483
neoadjuvantní38676748013159112171221281303360409459517548607628
chemoterapii45266748013149107160249307340391422472532554576
před2976689801316091141201
plánovanou3196689801316082130187244291340397454511
radikální3726689801313281140161205255276333354
operací40996898013158117170201250297318
a44376898013149
srovnat4506689801314070126173231279310
vliv483668980131497192140
na49966898013158106
přežití2976704801316192144188211244266
a32697048013150
frekvenci3347704801312961113159211263321370391
odpovědi37667048013158119178237286337397419
na42137048013159107
NACH43487048013170133192260
u46357048013159
pacientů47217048013161111159181234292323381
bez29767198013161115160
vstupně3168719801315090125183242301354
zvětšených3554719801314497149182224277335381428486
uzlin40727198013159103126148205
(cN0)4310719801312974142197224
a45667198013150
s46487198013141
klinickou472171980131477192150172220266323381
lymfadenopatií2976734801312371162189240299352410468529579611633655
(cN1–3).3655734801312974142190239288312328