Epidemiological Department, Veneto Region, Castelfranco Veneto, Italy.
J Urol. 2011 Jan;185(1):72-8. doi: 10.1016/j.juro.2010.09.015. Epub 2010 Nov 12.
We describe nationwide treatment patterns of muscle invasive bladder cancer, investigated determinants of cystectomy and provide contemporary trends in process of care measures in patients undergoing cystectomy.
We selected 40,388 patients 18 to 99 years old diagnosed with muscle invasive (stages II to IV) bladder cancer in 2003 to 2007 from the National Cancer Database. Treatment included cystectomy, neoadjuvant and adjuvant chemotherapy, chemotherapy without surgery and radiation therapy. In patients undergoing cystectomy we retrieved the procedure type (partial vs radical), lymphadenectomy extent and 30-day followup. Cystectomy determinants were assessed by Poisson regression with robust error variance. Perioperative mortality was analyzed by multilevel logistic regression.
The proportion of patients treated with cystectomy (42.9%) and radiation therapy (16.6%) remained stable with time while the incidence of those who received chemotherapy increased from 27.0% in 2003 to 34.5% in 2007 due to an increase in neoadjuvant chemotherapy and chemotherapy without surgery. The cystectomy rate decreased with age and was lower in racial/ethnic minorities (especially black patients), uninsured or Medicaid patients, patients residing in the South and Northeast, and those treated at nonteaching/research hospitals. The partial cystectomy rate decreased and lymphadenectomy extent increased with time. The perioperative mortality rate was 2.6% and it was higher at low vs very high volume hospitals (OR 1.71, 95% CI 1.26-2.32).
Recent nationwide data confirm ongoing improvements in process of care measures in patients who undergo cystectomy but also show marked differences in treatment patterns for muscle invasive bladder cancer by patient age, race, insurance status, geographic area and facility type.
我们描述了全国范围内肌层浸润性膀胱癌的治疗模式，研究了行膀胱切除术的决定因素，并提供了接受膀胱切除术患者的护理流程当代趋势。
我们从国家癌症数据库中选择了 2003 年至 2007 年间诊断为肌层浸润性（II 期至 IV 期）膀胱癌的 40388 名 18 至 99 岁的患者。治疗包括膀胱切除术、新辅助和辅助化疗、不手术和放疗化疗。在接受膀胱切除术的患者中，我们检索了手术类型（部分 vs 根治性）、淋巴结清扫范围和 30 天随访情况。采用具有稳健误差方差的泊松回归评估膀胱切除术的决定因素。采用多级逻辑回归分析围手术期死亡率。
接受膀胱切除术（42.9%）和放疗（16.6%）治疗的患者比例随时间保持稳定，而接受化疗的患者比例从 2003 年的 27.0%增加到 2007 年的 34.5%，原因是新辅助化疗和不手术化疗的增加。随着年龄的增长，膀胱切除术的比例下降，且在种族/民族（尤其是黑人患者）、未参保或医疗补助患者、居住在南部和东北部的患者以及在非教学/研究医院治疗的患者中较低。部分膀胱切除术的比例下降，淋巴结清扫范围增加。围手术期死亡率为 2.6%，低容量与高容量医院（OR 1.71，95%CI 1.26-2.32）相比更高。
最近的全国性数据证实了接受膀胱切除术患者的护理流程不断改善，但也表明肌层浸润性膀胱癌的治疗模式存在显著差异，包括患者年龄、种族、保险状况、地理位置和医疗机构类型。
