Gin Greg E, Ruel Nora H, Kardos Steven V, Sfakianos John P, Uchio Edward, Lau Clayton S, Yuh Bertram E
Division of Urology, VA Long Beach Healthcare System, Long Beach, CA.
Division of Biostatistics, City of Hope National Medical Center, Duarte, CA.
Urol Oncol. 2017 May;35(5):192-200. doi: 10.1016/j.urolonc.2016.11.017. Epub 2016 Dec 29.
Evidence for the use of perioperative chemotherapy (PC) in upper tract urothelial carcinoma (UTUC) is largely derived from level I evidence for invasive urothelial carcinoma of the bladder (UCB). There has been an increase in PC for urothelial carcinoma of the bladder, as it has disseminated into clinical practice. Therefore, we sought to not only analyze trends in the utilization of PC in UTUC, but also assess factors associated with its use in a large cancer registry database.
The National Cancer Database was queried for patients with UTUC who underwent extirpative surgery from 2004 to 2013. Predictors of receiving PC were identified using univariate and multivariate logistic regression. Temporal trends in the utilization of PC were also analyzed using a general analysis of variance linear model.
From 2004 to 2013, there was significant increase in PC for UTUC from 9.6% to 13.8% (P = 0.0003). Neoadjuvant chemotherapy increased from 0.7% to 2.1% (P = 0.0018), whereas adjuvant chemotherapy remained relatively stable at 11.3%. Significant predictors of receiving PC on multivariate analysis were private insurance, ureter as the primary site, poorly differentiated and undifferentiated grade, lymphovascular invasion, positive margins, clinical T3 or T4 disease, nodal metastasis, and reporting from an academic research program. Patients who were≥70 years old,>50 miles to treatment center, had tumor in the kidney, or had an increased Charlson-Deyo Score were significantly less likely to receive PC.
Over the time period studied, there has been an increase in the use of PC, primarily from increased administration of neoadjuvant chemotherapy. Its use is mostly associated with advanced pathologic characteristics. The study also highlights key demographic and socioeconomic differences that can help identify barriers to receiving PC and aid in making improvements in delivery of health care to patients with UTUC.
上尿路尿路上皮癌（UTUC）围手术期化疗（PC）应用的证据主要来源于膀胱浸润性尿路上皮癌（UCB）的I级证据。随着PC在临床实践中的广泛应用，膀胱癌的PC使用有所增加。因此，我们不仅试图分析UTUC中PC使用的趋势，还在一个大型癌症登记数据库中评估与其使用相关的因素。
查询国家癌症数据库中2004年至2013年接受根治性手术的UTUC患者。使用单因素和多因素逻辑回归确定接受PC的预测因素。还使用方差分析线性模型分析PC使用的时间趋势。
2004年至2013年，UTUC的PC使用率从9.6%显著增加到13.8%（P = 0.0003）。新辅助化疗从0.7%增加到2.1%（P = 0.0018），而辅助化疗保持相对稳定，为11.3%。多因素分析中接受PC的显著预测因素为私人保险、输尿管为主要部位、低分化和未分化分级、淋巴管浸润、切缘阳性、临床T3或T4期疾病、淋巴结转移以及来自学术研究项目的报告。年龄≥70岁、距离治疗中心>50英里、肾脏有肿瘤或Charlson-Deyo评分增加的患者接受PC的可能性显著降低。
在所研究的时间段内，PC的使用有所增加，主要是由于新辅助化疗的使用增加。其使用主要与晚期病理特征相关。该研究还突出了关键的人口统计学和社会经济差异，这些差异有助于识别接受PC的障碍，并有助于改善对UTUC患者的医疗服务。
