Chen Chin-Li, Liu Chin-Yu, Cha Tai-Lung, Hsu Chien-Yeh, Chou Yu-Ching, Wu Sheng-Tang, Meng En, Sun Guang-Huan, Yu Dah-Shyong, Tsao Chih-Wei
Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Department of Nutritional Science, Fu Jen Catholic University, New Taipei City, Taiwan, ROC.
J Chin Med Assoc. 2015 Aug;78(8):469-74. doi: 10.1016/j.jcma.2015.05.003.
To assess the impacts of age, performance status, and clinical stage on advanced urothelial carcinoma of the bladder (UCB) in patients treated with different treatment modalities.
This retrospective study included 160 patients who underwent radical cystectomy (RC) with/without neoadjuvant or adjuvant chemoradiotherapy, palliative chemotherapy/radiotherapy/chemoradiotherapy (CRT), and transurethral resection of bladder tumor (TURBT) monotherapy for advanced UCB in one institution from 2000 to 2010. Kaplan-Meier analysis was used to calculate the survival distributions of overall survival (OS). The quality of life of the patients was also analyzed.
The median age of the patients was 74.0 years, and the mean survival interval was 31.5 months. The 2-year OS was significantly different among the three modalities [RC > TURBT monotherapy, odds ratio (OR): 1.86, 95% CI: 1.17-2.96, p = 0.009; CRT > TURBT monotherapy, OR: 1.65, 95% CI: 1.06-2.57, p = 0.026]. There were no significant differences in the 5- and 10-year OS rates between the three treatment modalities. Those younger than 76 years receiving RC had a significantly better 2-year OS than those undergoing CRT and TURBT monotherapy (RC > TURBT monotherapy, OR: 2.38; 95% CI: 1.30-4.33, p = 0.005). The number and duration of re-hospitalizations were highest in the CRT group and lowest in the TURBT group.
The short- and long-term OS rates of the three modalities were similar in those older than 76 years. Therefore, patients younger than age 76 years are likely to have a better outcome undergoing radical cystectomy for advanced UCB.
评估年龄、体能状态和临床分期对接受不同治疗方式的晚期膀胱尿路上皮癌（UCB）患者的影响。
这项回顾性研究纳入了2000年至2010年在一家机构接受根治性膀胱切除术（RC）（伴或不伴新辅助或辅助放化疗）、姑息性化疗/放疗/放化疗（CRT）以及经尿道膀胱肿瘤切除术（TURBT）单药治疗晚期UCB的160例患者。采用Kaplan-Meier分析计算总生存期（OS）的生存分布。还对患者的生活质量进行了分析。
患者的中位年龄为74.0岁，平均生存间隔为31.5个月。三种治疗方式的2年总生存率有显著差异[根治性膀胱切除术>经尿道膀胱肿瘤切除术单药治疗，比值比（OR）：1.86，95%置信区间（CI）：1.17 - 2.96，p = 0.009；放化疗>经尿道膀胱肿瘤切除术单药治疗，OR：1.65，95% CI：1.06 - 2.57，p = 0.026]。三种治疗方式的5年和10年总生存率无显著差异。年龄小于76岁接受根治性膀胱切除术的患者2年总生存率显著高于接受放化疗和经尿道膀胱肿瘤切除术单药治疗的患者（根治性膀胱切除术>经尿道膀胱肿瘤切除术单药治疗，OR：2.38；95% CI：1.30 - 4.33，p = 0.005）。再住院次数和持续时间在放化疗组最高，在经尿道膀胱肿瘤切除术组最低。
76岁以上患者三种治疗方式的短期和长期总生存率相似。因此，76岁以下的晚期UCB患者接受根治性膀胱切除术可能有更好的预后。
