Cahn David B, Handorf Elizabeth, Ristau Benjamin T, Geynisman Daniel M, Simhan Jay, Kutikov Alexander, Greenberg Richard E, Viterbo Rosalia, Chen David Y T, Uzzo Robert G, Smaldone Marc C
Department of Urology, Einstein Healthcare Network, Philadelphia, PA; Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA.
Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA.
Urol Oncol. 2017 Dec;35(12):670.e15-670.e21. doi: 10.1016/j.urolonc.2017.07.026. Epub 2017 Aug 10.
Primary urethral carcinoma (PUC) has an aggressive natural history; however, controversy exists regarding the role of multimodal therapy for its treatment. Our objective was to examine practice patterns and survival outcomes for locally advanced urethral cancers.
The National Cancer Database was queried for patients with T2-4 or N1-2M0 PUC with urothelial, squamous, or adenocarcinoma histology from 2004 to 2013. Temporal trends for receipt of local or definitive surgery, radiotherapy (XRT), and systemic therapy were assessed. Adjusting for clinicopathologic characteristics, we evaluated the effect of tumor stage and histology on receipt of definitive multimodal therapy (cystectomy + chemotherapy ± XRT) and effects of treatment on overall survival.
A total of 1,749 patients met inclusion criteria (22.2% adenocarcinoma, 29.3% squamous, and 48.5% urothelial). Only 29.6% underwent cystectomy ± XRT, and 15.6% underwent definitive multimodal therapy. Following adjustment, older patients (age 50-75: odds ratio [OR] = 0.42 [95% CI: 0.28-0.63]; age 75+: OR = 0.06 [95% CI: 0.03-0.13]) and those with squamous histology (OR = 0.46 [95% CI: 0.3-0.7]) were less likely to receive definitive multimodal therapy. More advanced stage (T3: OR = 1.66 [95% CI: 1.15-2.41]; T4: OR = 3.57 [95% CI: 2.47-5.16]); and N2 status (OR = 1.88 [95% CI: 1.27-2.78]) were more likely to receive definitive multimodal therapy. On adjusted analysis, an overall survival benefit was only observed with definitive multimodal therapy for PUC of urothelial origin (hazard ratio = 0.61 [95% CI: 0.45-0.83]).
Despite a survival benefit, most patients with locally advanced PUC do not undergo definitive multimodal therapy. We advocate for a multidisciplinary-based treatment approach for these patients. Future prospective trials of multimodal therapy are crucial.
原发性尿道癌（PUC）具有侵袭性的自然病程；然而，关于多模式治疗在其治疗中的作用仍存在争议。我们的目的是研究局部晚期尿道癌的治疗模式和生存结果。
查询2004年至2013年国家癌症数据库中组织学类型为尿路上皮癌、鳞状细胞癌或腺癌的T2 - 4或N1 - 2M0期PUC患者。评估接受局部或根治性手术、放射治疗（XRT）和全身治疗的时间趋势。在调整临床病理特征后，我们评估了肿瘤分期和组织学对接受根治性多模式治疗（膀胱切除术 + 化疗 ± XRT）的影响以及治疗对总生存的影响。
共有1749例患者符合纳入标准（22.2%为腺癌，29.3%为鳞状细胞癌，48.5%为尿路上皮癌）。仅29.6%的患者接受了膀胱切除术 ± XRT，15.6%的患者接受了根治性多模式治疗。调整后，老年患者（年龄50 - 75岁：比值比[OR] = 0.42 [95%置信区间：0.28 - 0.63]；年龄75岁以上：OR = 0.06 [95%置信区间：0.03 - 0.13]）和鳞状组织学类型的患者（OR = 0.46 [95%置信区间：0.3 - 0.7]）接受根治性多模式治疗的可能性较小。分期越晚（T3：OR = 1.66 [95%置信区间：1.15 - 2.41]；T4：OR = 3.57 [95%置信区间：2.47 - 5.16]）以及N2状态（OR = 1.88 [95%置信区间：1.27 - 2.78]）的患者接受根治性多模式治疗的可能性更大。在调整分析中，仅观察到尿路上皮源性PUC接受根治性多模式治疗有总生存获益（风险比 = 0.61 [95%置信区间：0.45 - 0.83]）。
尽管有生存获益，但大多数局部晚期PUC患者未接受根治性多模式治疗。我们提倡对这些患者采用多学科治疗方法。未来多模式治疗的前瞻性试验至关重要。
