Cohen Andrew, Kuchta Kristine, Park Sangtae
Section of Urology, University of Chicago, Chicago, IL.
Division of Urology, NorthShore University HealthSystem, Evanston, IL.
Urol Oncol. 2017 Jun;35(6):322-327. doi: 10.1016/j.urolonc.2016.11.018. Epub 2017 Jan 5.
To determine trends in neoadjuvant and adjuvant chemotherapy use for upper tract urothelial cancer and assess its effects on survival.
We identified all patients diagnosed with upper tract urothelial cancer who underwent surgical treatment in the SEER-Medicare database from 2002 to 2011. We collected and analyzed patient demographic, clinical, and pathologic characteristics. We strictly defined neoadjuvant and adjuvant chemotherapy and studied patients who met such criteria. Multivariable Cox proportional hazards models identified were used to identify independent predictors of overall and cancer-specific survival.
A total of 3,432 patients met inclusion criteria, and their median age was 77 years. Overall, 86.4% of patients underwent surgery alone, 1.8% received neoadjuvant chemotherapy plus surgery, and 11.8% underwent surgery and adjuvant chemotherapy. Neoadjuvant chemotherapy use increased during the study period. Gemcitabine, carboplatin, cisplatin, and paclitaxel were the most commonly used agents. Cancer-specific survival at 5 years was 65.0% (95% CI: 63.2%-66.8%). Cox proportional hazards modeling controlling for sex, race, year of diagnosis, location, and pathologic stage revealed that higher pathologic nodal stage, tumor size>3cm, increased age, and carcinoma in situ predicted for worse survival.
Age, nodal stage, and tumor size>3cm predict for worse cancer-specific survival. Neoajduvant chemotherapy is underused.
确定上尿路尿路上皮癌新辅助化疗和辅助化疗的使用趋势，并评估其对生存率的影响。
我们在监测、流行病学和最终结果（SEER）-医疗保险数据库中识别出2002年至2011年期间所有接受手术治疗的上尿路尿路上皮癌患者。我们收集并分析了患者的人口统计学、临床和病理特征。我们严格定义了新辅助化疗和辅助化疗，并研究了符合这些标准的患者。使用多变量Cox比例风险模型来识别总生存率和癌症特异性生存率的独立预测因素。
共有3432例患者符合纳入标准，他们的中位年龄为77岁。总体而言，86.4%的患者仅接受了手术，1.8%的患者接受了新辅助化疗加手术，11.8%的患者接受了手术和辅助化疗。在研究期间，新辅助化疗的使用有所增加。吉西他滨、卡铂、顺铂和紫杉醇是最常用的药物。5年癌症特异性生存率为65.0%（95%置信区间：63.2%-66.8%）。控制性别、种族、诊断年份、部位和病理分期的Cox比例风险模型显示，较高的病理淋巴结分期、肿瘤大小>3cm、年龄增加和原位癌预示着生存率较差。
年龄、淋巴结分期和肿瘤大小>3cm预示着癌症特异性生存率较差。新辅助化疗未得到充分利用。
