Joudi Fadi N, Smith Brian J, O'Donnell Michael A, Konety Badrinath R
University of Iowa Holden Comprehensive Cancer Center and Department of Urology, Iowa City, Iowa 52242-1089, USA.
J Urol. 2006 May;175(5):1634-9; discussion 1639-40. doi: 10.1016/S0022-5347(05)00973-0.
We determined the influence of age on response to intravesical immunotherapy in patients with superficial bladder cancer.
Data from a national phase II multicenter trial for BCG plus IFN-alpha intravesical therapy for superficial bladder cancer were analyzed. Recurrence-free survival 2 years after the initiation of therapy was examined in patients by incremental age decade. BCG-N patients received 81 mg BCG and 50 MU IFN-alpha, while patients who had previously been treated with BCG received a third of the BCG dose with 50 MU IFN-alpha and those who were BCG intolerant received a tenth of the BCG dose with 100 MU IFN-alpha. Kaplan-Meier survival curves were obtained.
In all patients the largest difference in response was between the 289 who were 61 to 70 years old and the 123 who were older than 80 years with a 22% difference in cancer-free survival at a median followup of 24 months (61% vs 39%, p = 0.0002). When we assessed BCG-N and BCG treated patients separately in the 2 age groups, patients older than 80 years had a persistently lower response rate than younger patients 61 to 70 years old. Of BCG-N patients those older than 80 and younger than 50 years had the lowest cancer-free survival at a median followup of 24 months (47% and 45%, respectively). On multivariate analysis age was an independent risk factor for response.
Aging appears to be associated with a decreased response to intravesical immunotherapy and is particularly apparent in patients older than 80 years. A potential explanation could be their depressed baseline immune status and consequent inability to mount an immune reaction to BCG or IFN-alpha.
我们确定了年龄对浅表性膀胱癌患者膀胱内免疫治疗反应的影响。
分析了一项全国性II期多中心试验的数据，该试验为卡介苗加α干扰素膀胱内治疗浅表性膀胱癌。按年龄每增加十岁分组，对治疗开始后2年的无复发生存率进行了检查。卡介苗初治患者接受81mg卡介苗和50MUα干扰素，而先前接受过卡介苗治疗的患者接受三分之一剂量的卡介苗加50MUα干扰素，卡介苗不耐受患者接受十分之一剂量的卡介苗加100MUα干扰素。绘制了Kaplan-Meier生存曲线。
在所有患者中，反应差异最大的是289名61至70岁的患者和123名80岁以上的患者，在中位随访24个月时，无癌生存率相差22%（61%对39%，p = 0.0002）。当我们在两个年龄组中分别评估卡介苗初治患者和卡介苗治疗过的患者时，80岁以上的患者反应率持续低于61至70岁的年轻患者。在卡介苗初治患者中，80岁以上和50岁以下的患者在中位随访24个月时无癌生存率最低（分别为47%和45%）。多因素分析显示年龄是反应的独立危险因素。
衰老似乎与膀胱内免疫治疗反应降低有关，在80岁以上的患者中尤为明显。一个可能的解释是他们的基线免疫状态低下，因此无法对卡介苗或α干扰素产生免疫反应。
