Gotto Geoffrey T, Shea-Budgell Melissa A, Rose M Sarah, Ruether J Dean
Department of Surgery, Cumming School of Medicine, University of Calgary, Southern Alberta Institute of Urology, Calgary, AB;
Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary, AB; ; Alberta Health Services, Calgary, AB.
Can Urol Assoc J. 2015 Jul-Aug;9(7-8):236-41. doi: 10.5489/cuaj.2722.
In patients with non-metastatic muscle-invasive bladder cancer (MIBC) fit for curative therapy, a multidisciplinary approach consisting is recommended. This approach includes local treatment (usually radical cystectomy), ideally combined with neoadjuvant chemotherapy (NACT). Despite a survival benefit with NACT, uptake remains low. We assessed NACT consultation in Alberta and examined associative factors, as well as the relationship to survival.
Patients with MIBC were identified through the Alberta Cancer Registry. Demographic and clinicopathologic information was collected from electronic medical records between 2007 and 2011. In addition to descriptive statistics, logistic regression was used to determine factors associated with receiving NACT consultation. Overall survival was described using a Kaplan-Meier estimate.
Of the 315 radical cystectomy patients, 140 (45.1%, 95% confidence interval [CI] 39.5, 50.8) received NACT consultation. Patients ≥80 years (odds ratio [OR] 0.21, 95% CI 0.08, 0.57, p = 0.002) and those treated in Calgary (OR 0.11, 95% CI 0.05, 0.25, p < 0.001) were less likely to receive NACT consultation. The rate of NACT consultation increased steadily from 2007 to 2011 (OR 1.23, 95% CI 1.04, 1.45 per year of diagnosis, p = 0.018). After a median follow-up of 28.1 months (range: 14.6-50.3), median survival was 54.7 months for patients who received NACT consultation versus 31.2 months for those who did not (p = 0.030).
NACT consultation in patients with MIBC undergoing radical cystectomy has improved over time; however, regional differences underscore the need for a standardized approach to NACT consultation, including common referral mechanisms.
对于适合进行根治性治疗的非转移性肌层浸润性膀胱癌（MIBC）患者，推荐采用多学科治疗方法。这种方法包括局部治疗（通常为根治性膀胱切除术），理想情况下联合新辅助化疗（NACT）。尽管NACT能带来生存获益，但接受率仍然较低。我们评估了艾伯塔省的NACT会诊情况，并研究了相关因素以及与生存的关系。
通过艾伯塔癌症登记处识别出MIBC患者。收集了2007年至2011年间电子病历中的人口统计学和临床病理信息。除描述性统计外，采用逻辑回归确定与接受NACT会诊相关的因素。使用Kaplan-Meier估计描述总生存期。
在315例行根治性膀胱切除术的患者中，140例（45.1%，95%置信区间[CI] 39.5，50.8）接受了NACT会诊。80岁及以上患者（比值比[OR] 0.21，95% CI 0.08，0.57，p = 0.002）以及在卡尔加里接受治疗的患者（OR 0.11，95% CI 0.05，0.25，p < 0.001）接受NACT会诊的可能性较小。从2007年到2011年，NACT会诊率稳步上升（OR 1.23，95% CI 1.04，每年诊断增加1.45，p = 0.018）。中位随访28.1个月（范围：14.6 - 50.3个月）后，接受NACT会诊的患者中位生存期为54.7个月，未接受会诊的患者为31.2个月（p = 0.030）。
随着时间推移，接受根治性膀胱切除术的MIBC患者的NACT会诊情况有所改善；然而，地区差异凸显了对NACT会诊采用标准化方法的必要性，包括通用的转诊机制。
