Lewis Gary D, Haque Waqar, Verma Vivek, Butler E Brian, Teh Bin S
Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA.
Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA.
Bladder Cancer. 2018 Apr 26;4(2):205-213. doi: 10.3233/BLC-180163.
The standard of care for locally advanced bladder cancer (LABC) is neoadjuvant chemotherapy followed by cystectomy. However, the role of adjuvant therapy for locally advanced bladder cancer is unclear.
The purpose of this study was to evaluate the outcomes of adjuvant radiation therapy (RT) for patients with LABC, and to determine which risk factors best predict for patients who may best benefit from adjuvant RT.
The National Cancer Data Base (NCDB) was queried (2004- 2013) for patients with newly-diagnosed pT3-4N0-3M0 urothelial carcinoma of the bladder that received neoadjuvant chemotherapy and cystectomy. Patients were divided into two groups based on the adjuvant therapy they received: RT or observation. Statistics included multivariable logistic regression to determine factors predictive of receiving adjuvant RT, Kaplan-Meier analysis to evaluate overall survival (OS), and Cox proportional hazards modeling to determine variables associated with OS.
Altogether, 1,646 patients met inclusion criteria; 59 (3.6%) patients received adjuvant RT, while 1,587 (96.4%) were observed. Patients treated with adjuvant RT were more likely to be female, have positive surgical margins, and receive treatment at a non-academic facility. There was no difference in median overall survival (OS) between patients treated with RT when compared to patients observed (17.7 months vs. 23.5 months; = 0.085). However, an improvement in median OS with the use of adjuvant RT was observed among patients with positive surgical margins (20.3 months vs. 13.1 months; = 0.032). On multivariate analysis, advancing age, pT4 stage, positive N stage, positive margins, and lower socioeconomic status were associated with worse OS.
In the largest study to date evaluating efficacy of adjuvant radiotherapy in patients with locally advanced bladder cancer, use of RT was not associated with OS in all patients, while RT was associated with improvemed OS among patients with positive surgical margins. Prospective studies are recommended to confirm these findings.
局部晚期膀胱癌（LABC）的标准治疗方案是新辅助化疗后行膀胱切除术。然而，辅助治疗在局部晚期膀胱癌中的作用尚不清楚。
本研究旨在评估辅助放疗（RT）对局部晚期膀胱癌患者的疗效，并确定哪些危险因素最能预测可能从辅助放疗中获益最大的患者。
查询国家癌症数据库（NCDB，2004 - 2013年）中确诊为pT3 - 4N0 - 3M0膀胱尿路上皮癌且接受新辅助化疗和膀胱切除术的患者。根据接受的辅助治疗将患者分为两组：放疗组或观察组。统计方法包括多变量逻辑回归以确定接受辅助放疗的预测因素、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总生存期相关的变量。
共有1646例患者符合纳入标准；59例（3.6%）患者接受了辅助放疗，而1587例（96.4%）患者接受观察。接受辅助放疗的患者更可能为女性、手术切缘阳性且在非学术机构接受治疗。与接受观察的患者相比，接受放疗的患者中位总生存期无差异（17.7个月对23.5个月；P = 0.085）。然而，手术切缘阳性的患者使用辅助放疗后中位总生存期有所改善（20.3个月对13.1个月；P = 0.032）。多变量分析显示，年龄增长、pT4期、N分期阳性、切缘阳性以及社会经济地位较低与较差的总生存期相关。
在迄今为止评估辅助放疗对局部晚期膀胱癌患者疗效的最大规模研究中，放疗并非与所有患者的总生存期相关，而放疗与手术切缘阳性患者的总生存期改善相关。建议进行前瞻性研究以证实这些发现。
