Haque Waqar, Verma Vivek, Butler E Brian, Teh Bin S
Department of Radiation Oncology, Greater Houston Physicians Medical Association, Houston, TX.
Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE.
Clin Genitourin Cancer. 2017 Sep 6. doi: 10.1016/j.clgc.2017.08.013.
Management of cT4b bladder cancer is poorly defined; national guidelines recommend chemotherapy (CT) alone or chemoradiation (CRT). Using a large, contemporary dataset, we evaluated national practice patterns as well as associated outcomes, especially with respect to radical cystectomy (RC) and CRT versus CT alone.
The National Cancer Data Base was queried (2004-2013) for patients diagnosed with cT4bN0-3M0 bladder cancer. Patients were divided into 5 treatment groups: CT alone, CRT, RC (with/without CT/radiotherapy [RT]), other treatment (subtherapeutic RT with/without CT), or no treatment. Statistics included multivariable logistic regression to determine factors predictive of observation, Kaplan-Meier analysis to evaluate overall survival (OS), and Cox proportional hazards modeling to determine variables associated with OS.
Of 896 total patients, 185 (20.6%) underwent CT alone, 80 (8.9%) CRT, 161 (18.9%) RC, 221 (24.7%) other treatments, and 249 (27.8%) observation. Differences in treatment paradigms were appreciated based on age, gender, nodal status, insurance, and facility-related parameters. Observation yielded a median OS of 3.7 months, lower than CT alone (P < .001). As compared with the latter, CRT was associated with higher OS (10.5 vs. 12.1 months, P = .004). RC-based treatment displayed the numerically highest OS (14.2 months) and was statistically similar to CRT (P = .676). Treatment with any modality independently predicted for superior OS over observation.
In the largest study of its kind, a surprisingly high proportion of patients underwent observation. CRT is associated with higher survival over CT alone, and carefully selected patients undergoing RC may experience prolonged survival.
cT4b期膀胱癌的治疗方案尚无明确定义；国家指南推荐单纯化疗（CT）或放化疗（CRT）。我们利用一个大型的当代数据集，评估了全国的治疗模式以及相关结局，尤其是关于根治性膀胱切除术（RC）和CRT与单纯CT的比较。
查询国家癌症数据库（2004 - 2013年）中诊断为cT4bN0 - 3M0期膀胱癌的患者。患者分为5个治疗组：单纯CT、CRT、RC（有/无CT/放疗[RT]）、其他治疗（辅助性RT伴/不伴CT）或未治疗。统计方法包括多变量逻辑回归以确定预测观察的因素、Kaplan - Meier分析以评估总生存期（OS），以及Cox比例风险模型以确定与OS相关的变量。
在896例患者中，185例（20.6%）接受单纯CT治疗，80例（8.9%）接受CRT治疗，161例（18.9%）接受RC治疗，221例（24.7%）接受其他治疗，249例（27.8%）接受观察。基于年龄、性别、淋巴结状态、保险和机构相关参数，治疗模式存在差异。观察的中位OS为3.7个月，低于单纯CT治疗（P <.001）。与单纯CT相比，CRT的OS更高（10.5个月对12.1个月，P =.004）。基于RC的治疗在数值上显示出最高的OS（14.2个月），且与CRT在统计学上相似（P =.676）。任何一种治疗方式独立预测的OS均优于观察。
在同类最大规模的研究中，接受观察的患者比例高得出奇。与单纯CT相比，CRT的生存率更高，经过精心挑选接受RC治疗的患者可能生存期延长。
