Department of Urology, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
Division of Biostatistics, Department of Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
BJU Int. 2018 May;121(5):745-751. doi: 10.1111/bju.14109. Epub 2018 Jan 22.
To compare survival outcome between chemoradiation therapy (CRT) and radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC).
We conducted a retrospective analysis of patients with MIBC (≥cT2, N0, M0) in the National Cancer Database (2004-2013). CRT was defined as a radiation dose of ≥40 Gy and chemotherapy within 90 days of radiation. Descriptive statistics were used to compare groups. RC and CRT patients were propensity matched. Kaplan-Meier analysis was used to compare overall survival (OS). Multivariable Cox regression was used to determine predictors of survival.
In all, 8 379 (6 606 RC and 1 773 CRT) patients met the inclusion criteria and 1 683 patients in each group were propensity matched. On multivariable extended Cox analysis, significant predictors of decreased OS were age, Charlson-Deyo Comorbidity score of 1, Charlson-Deyo Comorbidity score of 2, stage cT3-4, and urothelial histology. CRT was associated with decreased mortality at year 1 (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.74-0.96; P = 0.01), but at 2 years (HR 1.4, 95% CI 1.2-1.6; P < 0.001) and 3 years onward (HR 1.5, 95% CI 1.2-1.8; P < 0.001) CRT was associated with increased mortality. The 5-year OS was greater for RC than for CRT (38% vs 30%, P = 0.004).
Initially after treatment for MIBC the risk of mortality is lower with CRT compared to RC. However, at ≥2 years after treatment the mortality risk favours RC. Patients who are suitable surgical candidates, with a low risk of morbidity, may be better served by RC.
比较肌层浸润性膀胱癌（MIBC）患者接受放化疗（CRT）与根治性膀胱切除术（RC）的生存结局。
我们对国家癌症数据库（2004-2013 年）中 MIBC（≥cT2、N0、M0）患者进行了回顾性分析。CRT 定义为放疗剂量≥40Gy，且在放疗后 90 天内进行化疗。采用描述性统计比较各组。RC 和 CRT 患者进行倾向评分匹配。采用 Kaplan-Meier 分析比较总生存（OS）。采用多变量 Cox 回归确定生存的预测因素。
共纳入 8379 例（6606 例 RC 和 1773 例 CRT）患者，每组 1683 例患者进行倾向评分匹配。多变量扩展 Cox 分析显示，OS 降低的显著预测因素为年龄、Charlson-Deyo 合并症评分 1 分、Charlson-Deyo 合并症评分 2 分、cT3-4 期和尿路上皮组织学。CRT 治疗后 1 年（风险比 [HR]0.84，95%置信区间 [CI]0.74-0.96；P=0.01）死亡率降低，但在 2 年（HR 1.4，95% CI 1.2-1.6；P<0.001）和 3 年及以后（HR 1.5，95% CI 1.2-1.8；P<0.001）死亡率增加。RC 的 5 年 OS 大于 CRT（38% vs 30%，P=0.004）。
MIBC 初始治疗后，CRT 与 RC 相比，死亡风险较低。然而，治疗后≥2 年，RC 的死亡风险更有利。对于适合手术且发病率低的患者，RC 可能是更好的选择。
