Poletajew Sławomir, Biernacki Radosław, Buraczyński Paweł, Chojnacki Jarosław, Czarniecki Stefan, Gajewska Dominika, Pohaba Tomasz, Sondka Joanna, Skrzypczyk Michał, Suchojad Tomasz, Wojtkowiak Dominik, Zaforemski Bogusław, Zapała Łukasz, Zemła Aleksandra, Radziszewski Piotr
Department of Urology, Medical University of Warsaw, Warsaw, Poland.
Department of Urology, The Regional Hospital, Leszno, Poland.
Contemp Oncol (Pozn). 2016;20(4):341-3. doi: 10.5114/wo.2016.61857. Epub 2016 Sep 5.
A potential reason for poor survival among patients with muscle-invasive bladder cancer (MIBC) in Poland is initial disqualification from curative treatment due to advanced stage of the disease or low performance status. The aim of this study was to describe patterns of care in patients with newly diagnosed MIBC. This is a multicentre retrospective cohort study involving 296 consecutive patients with primary histologically diagnosed MIBC. Therapeutic decisions and potentially underlying clinical factors were analysed. Full clinical data was available for 285 patients. One hundred and sixty-four (57.5%) patients were qualified for radical cystectomy (RC), 32 (11.2%) patients for a second step of transurethral resection of the bladder tumour (TURBT) intentionally followed by systemic chemotherapy, four (1.4%) patients after complete TURBT were qualified for adjuvant intravesical chemotherapy only, while the remaining 85 (29.8%) patients were qualified for palliative treatment in the form of chemotherapy and/or radiotherapy and/or best supportive care. Patients disqualified from curative treatment were older (78 vs. 69 years, p < 0.02), had lower BMI values (24.5 vs. 25.7 kg/m(2), p < 0.02), lower haemoglobin concentration (11.6 vs. 12.9 mg/l, p < 0.02), declared lower rate of nicotine abuse (50.5% vs. 72.1%, p < 0.02), and had a shorter time interval between first symptom and diagnosis (30 vs. 60 days, p = 0.02). As the majority of Polish patients with primary MIBC receive curative treatment, the stage of the disease alone seems not to be the leading cause of poor survival. However, appropriateness of qualification for RC and treatment quality needs to be assessed for final conclusion on the factors influencing outcomes of treatment in Poland.
在波兰，肌肉浸润性膀胱癌（MIBC）患者生存率低的一个潜在原因是，由于疾病分期较晚或身体状况不佳，患者最初被判定不适合进行根治性治疗。本研究的目的是描述新诊断的MIBC患者的治疗模式。这是一项多中心回顾性队列研究，纳入了296例经组织学确诊为原发性MIBC的连续患者。分析了治疗决策和潜在的临床因素。285例患者有完整的临床数据。164例（57.5%）患者符合根治性膀胱切除术（RC）条件，32例（11.2%）患者符合第二步经尿道膀胱肿瘤切除术（TURBT）并有意接受全身化疗，4例（1.4%）患者在完全TURBT后仅符合辅助膀胱内化疗条件，其余85例（29.8%）患者符合以化疗和/或放疗和/或最佳支持治疗形式的姑息治疗条件。被判定不适合进行根治性治疗的患者年龄较大（78岁对69岁，p<0.02），体重指数较低（24.5对25.7kg/m²，p<0.02），血红蛋白浓度较低（11.6对12.9mg/l，p<0.02），宣称尼古丁滥用率较低（50.5%对72.1%，p<0.02），且首发症状与诊断之间的时间间隔较短（30天对60天，p = 0.02）。由于大多数波兰原发性MIBC患者接受根治性治疗，疾病分期似乎并非生存率低的主要原因。然而，对于影响波兰治疗结果的因素得出最终结论，需要评估RC资格的适宜性和治疗质量。
