Schiffmann Jonas, Sun Maxine, Gandaglia Giorgio, Tian Zeh, Popa Ioana, Larcher Alessandro, Briganti Alberto, McCORMACK Michael, Shariat Shahrokh F, Montorsi Francesco, Graefen Markus, Saad Fred, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada -
Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany -
Minerva Urol Nefrol. 2017 Apr;69(2):173-180. doi: 10.23736/S0393-2249.16.02713-2. Epub 2016 Oct 12.
The role of adjuvant chemotherapy (AC) within urothelial carcinoma of the urinary bladder (UCUB) patients after radical cystectomy (RC) is under debate. We assessed contemporary AC utilization rates. We also examined the rates of AC according to patient disease and sociodemographic characteristics.
We relied on the SEER-Medicare database for non-organ-confined, muscle-invasive T2 N+ -T4a UCUB patients who underwent RC between 1991 and 2009 without neoadjuvant chemotherapy delivery. Multivariable logistic regression analyses tested predictors of AC use; T-stage, N-stage, year of diagnosis, age, gender, race, radiotherapy (RT) administration, marital urban and socioeconomic status, tumor grade and Charlson Comorbidity Index (CCI).
Overall, 2681 patients were identified. Of those, 667 (24.9%) received AC. The rate of AC were 21.4%, 23.5%, 24.6% and 29.9% over time (1991-1999 vs. 2000-2002 vs. 2003-2005 vs. 2006-2009) (P=0.002). In multivariable analyses stages pT2N+ (odds ratio (OR): 4.7; P<0.001) and pT3/4aN+ (OR: 4.0; P<0.001), year of diagnosis (OR: 1.9; P<0.001), RT (OR: 1.7; P<0.001), married status (OR: 1.4; P=0.001) and advanced age (OR: 0.3; P<0.001) were independent predictors of AC. Neither race nor CCI demonstrated significance.
In conclusion, we report lower than anticipated overall (24.9%) use of AC. Nonetheless, the rate increased from 13.6% (1991) to 24.1% (2009). Presence of lymph node invasion at RC regardless of T2 or T3/4a stage was the most important variable that increased AC use. Older and unmarried individuals were less likely to receive AC. AC rates were higher in T2N+ UCUB patients than in T3-T4a individuals.
辅助化疗（AC）在根治性膀胱切除术（RC）后膀胱尿路上皮癌（UCUB）患者中的作用仍存在争议。我们评估了当代AC的使用率。我们还根据患者疾病和社会人口统计学特征检查了AC的使用率。
我们依赖SEER - 医疗保险数据库，纳入1991年至2009年间接受RC且未接受新辅助化疗的非器官局限性、肌层浸润性T2 N + -T4a UCUB患者。多变量逻辑回归分析测试了AC使用的预测因素；T分期、N分期、诊断年份、年龄、性别、种族、放疗（RT）使用情况、婚姻状况、城市和社会经济状况、肿瘤分级和查尔森合并症指数（CCI）。
总体而言，共识别出2681例患者。其中，667例（24.9%）接受了AC。随着时间推移（1991 - 1999年 vs. 2000 - 2002年 vs. 2003 - 2005年 vs. 2006 - 2009年），AC使用率分别为21.4%、23.5%、24.6%和29.9%（P = 0.002）。在多变量分析中，pT2N + 期（比值比（OR）：4.7；P < 0.001）和pT3/4aN + 期（OR：4.0；P < 0.001）、诊断年份（OR：1.9；P < 0.001）、RT（OR：1.7；P < 0.001）、已婚状态（OR：1.4；P = 0.001）和高龄（OR：0.3；P < 0.001）是AC使用的独立预测因素。种族和CCI均无统计学意义。
总之，我们报告的AC总体使用率（24.9%）低于预期。尽管如此，该率从1991年的13.6%上升至2009年的24.1%。无论T2或T3/4a期，RC时存在淋巴结浸润是增加AC使用的最重要变量。年龄较大和未婚个体接受AC的可能性较小。T2N + UCUB患者的AC使用率高于T3 - T4a患者。
