Williams Stephen B, Huo Jinhai, Kosarek Christopher D, Chamie Karim, Rogers Selwyn O, Williams Michele A, Giordano Sharon H, Kim Simon P, Kamat Ashish M
The Division of Urology, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
The Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, USA.
Cancer Causes Control. 2017 Jul;28(7):755-766. doi: 10.1007/s10552-017-0902-2. Epub 2017 May 5.
Radical cystectomy is a surgical treatment for recurrent non-muscle-invasive and muscle-invasive bladder cancer; however, many patients may not receive this treatment.
A total of 27,578 patients diagnosed with clinical stage I-IV bladder cancer from 1 January 2007 to 31 December 2013 were identified from the Surveillance, Epidemiology, and End Results (SEER) registry database. We used multivariable regression analyses to identify factors predicting the use of radical cystectomy and pelvic lymph node dissection. Cox proportional hazards models were used to analyze survival outcomes.
A total of 1,693 (6.1%) patients with bladder cancer underwent radical cystectomy. Most patients (92.4%) who underwent radical cystectomy also underwent pelvic lymph node dissection. When compared with white patients, non-Hispanic blacks were less likely to undergo a radical cystectomy [odds ratio (OR) 0.79, 95% confidence interval (CI) 0.64-0.96, p = 0.019]. Moreover, recent year of surgery 2013 versus 2007 (OR 2.32, 95% CI 1.90-2.83, p < 0.001), greater percentage of college education ≥36.3 versus <21.3% (OR 1.23, 95% CI 1.04-1.44, p = 0.013), Midwest versus West (OR 1.64, 95% CI 1.39-1.94, p < 0.001), and more advanced clinical stage III versus I (OR 29.1, 95% CI 23.9-35.3, p < 0.001) were associated with increased use of radical cystectomy. Overall survival was improved for patients who underwent radical cystectomy compared with those who did not undergo a radical cystectomy (hazard ratio 0.88, 95% CI 0.80-0.97, p = 0.008).
There is significant underutilization of radical cystectomy in patients across all age groups diagnosed with bladder cancer, especially among older, non-Hispanic black patients.
根治性膀胱切除术是复发性非肌层浸润性和肌层浸润性膀胱癌的一种外科治疗方法；然而，许多患者可能无法接受这种治疗。
从监测、流行病学和最终结果（SEER）登记数据库中识别出2007年1月1日至2013年12月31日期间共27578例诊断为临床I-IV期膀胱癌的患者。我们使用多变量回归分析来确定预测根治性膀胱切除术和盆腔淋巴结清扫术使用情况的因素。采用Cox比例风险模型分析生存结果。
共有1693例（6.1%）膀胱癌患者接受了根治性膀胱切除术。大多数接受根治性膀胱切除术的患者（92.4%）也接受了盆腔淋巴结清扫术。与白人患者相比，非西班牙裔黑人接受根治性膀胱切除术的可能性较小[比值比（OR）0.79，95%置信区间（CI）0.64-0.96，p = 0.019]。此外，手术年份较近的2013年与2007年相比（OR 2.32，95%CI 1.90-2.83，p < 0.001）、大学教育程度较高的比例≥36.3%与<21.3%相比（OR 1.23，95%CI 1.04-1.44，p = 0.013）、中西部地区与西部地区相比（OR 1.64，95%CI 1.39-1.94，p < 0.001）以及临床分期较晚的III期与I期相比（OR 29.1，95%CI 23.9-35.3，p < 0.001）均与根治性膀胱切除术使用增加相关。与未接受根治性膀胱切除术的患者相比，接受根治性膀胱切除术的患者总生存期有所改善（风险比0.88，95%CI 0.80-0.97，p = 0.008）。
在所有诊断为膀胱癌的年龄组患者中，根治性膀胱切除术的使用率明显不足，尤其是在老年非西班牙裔黑人患者中。
