Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston; Department of Oncology; Department of Public Health Sciences.
Department of Oncology; Department of Urology, Queen's University, Kingston.
Ann Oncol. 2014 Sep;25(9):1783-1788. doi: 10.1093/annonc/mdu204. Epub 2014 Jun 10.
Few articles have documented regimens and timing of perioperative chemotherapy for bladder cancer in routine practice. Here, we describe practice patterns in the general population of Ontario, Canada.
In this retrospective cohort study, treatment and physician billing records were linked to the Ontario Cancer Registry to describe use of neoadjuvant (NACT) and adjuvant (ACT) chemotherapy among all patients with muscle-invasive bladder cancer treated with cystectomy in Ontario 1994-2008. Time to initiation of ACT (TTAC) was measured from cystectomy. Multivariate Cox regression was used to identify factors associated with overall (OS) and cancer-specific survival (CSS).
Of 2944 patients undergoing cystectomy, 4% (129/2944) and 19% (571/2944) were treated with NACT and ACT, respectively. Five-year OS was 25% [95% confidence interval (CI) 17% to 34%] for NACT, 29% (95% CI 25% to 33%) for ACT cases. Among patients with identifiable drug regimens, cisplatin was used in 82% (253/308) and carboplatin in 14% (43/308). The most common regimens were gemcitabine-cisplatin (54%, 166/308) and methotrexate, vinblastine, doxorubicin, cisplatin (MVAC) (21%, 66/308). Mean TTAC was 10 weeks; 23% of patients had TTAC >12 weeks. TTAC >12 weeks was associated with inferior OS [hazard ratio (HR) 1.28, 95% CI 1.00-1.62] and CSS (HR 1.30, 95% CI 1.00-1.69). In adjusted analyses, OS and CSS were lower among patients treated with carboplatin compared with those treated with cisplatin; OS HR 2.14 (95% CI 1.40-3.29) and CSS HR 2.06 (95% CI 1.26-3.37).
Most patients in the general population receive cisplatin, and this may be associated with superior outcomes to carboplatin. Initiation of ACT beyond 12 weeks is associated with inferior survival. Patients should start ACT as soon as they are medically fit to do so.
很少有文章记录膀胱癌围手术期化疗的方案和时间安排在常规实践中。在这里，我们描述了加拿大安大略省普通人群中的实践模式。
在这项回顾性队列研究中，通过与安大略癌症登记处的链接，对 1994 年至 2008 年间在安大略省接受膀胱癌根治性切除术的所有肌层浸润性膀胱癌患者的新辅助化疗（NACT）和辅助化疗（ACT）的使用情况进行了描述。从膀胱癌根治性切除术开始测量 ACT 的开始时间（TTAC）。多变量 Cox 回归用于确定与总生存（OS）和癌症特异性生存（CSS）相关的因素。
在 2944 例接受膀胱癌根治性切除术的患者中，分别有 4%（129/2944）和 19%（571/2944）接受了 NACT 和 ACT 治疗。NACT 的 5 年 OS 为 25%[95%置信区间（CI）17%至 34%]，ACT 病例的 5 年 OS 为 29%（95% CI 25%至 33%）。在可识别药物方案的患者中，顺铂的使用率为 82%（253/308），卡铂的使用率为 14%（43/308）。最常见的方案是吉西他滨-顺铂（54%，166/308）和甲氨蝶呤、长春碱、多柔比星、顺铂（MVAC）（21%，66/308）。平均 TTAC 为 10 周；23%的患者 TTAC>12 周。TTAC>12 周与较差的 OS[风险比（HR）1.28，95%置信区间（CI）1.00-1.62]和 CSS（HR 1.30，95%置信区间（CI）1.00-1.69）相关。在调整后的分析中，与接受顺铂治疗的患者相比，接受卡铂治疗的患者 OS 和 CSS 较低；OS HR 2.14（95%CI 1.40-3.29）和 CSS HR 2.06（95%CI 1.26-3.37）。
大多数普通人群中的患者接受顺铂治疗，这可能与卡铂相比具有更好的疗效。ACT 开始时间超过 12 周与生存不良相关。一旦患者身体状况允许，应尽快开始 ACT。
