Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois.
Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois.
Int J Radiat Oncol Biol Phys. 2018 Oct 1;102(2):304-313. doi: 10.1016/j.ijrobp.2018.06.007. Epub 2018 Aug 7.
Urethral cancer is rare, with limited data guiding treatment. A national hospital-based registry was used to evaluate the role of local therapy in these patients.
We performed a retrospective cohort study of patients who, between 2004 and 20013, received a diagnosis of T0-4N0-2 M0 urethral cancer. Local therapy was radiation therapy (RT), surgery (S), or S and RT (S+RT). The Cox proportional hazards model was used to assess the impact of therapy type on overall survival (primary endpoint). Subgroup analysis by extent of disease (early stage [T0-2 N0] vs locally advanced [T3+ or N+]) and histology was performed.
In our study, 2614 patients had a median follow-up of 28 months. Three-year overall survival was 54%. In 501 patients with locally advanced disease, S+RT was associated with improved survival versus S alone (hazard ratio [HR] 0.58; 95% confidence interval [CI], 0.42-0.80). There was no difference for patients with squamous cell carcinoma by treatment type, but patients with adenocarcinoma (RT vs S: HR 0.20; 95% CI, 0.07-0.60) or transitional cell carcinoma (S+RT vs S: HR 0.45, 95% CI, 0.26-0.77) had improved OS with RT as part of treatment. In 1705 early-stage patients, there was no association with survival when comparing S+RT versus S.
For patients with locally advanced disease and transitional cell carcinoma undergoing S, the addition of RT is associated with improved overall survival and should be considered. An RT-based approach may be preferred for adenocarcinoma, but there was no clear association with survival by therapy type for squamous cell carcinoma. This study is hypothesis generating; prospective trials are necessary.
尿道癌较为罕见，治疗方法主要依据有限的临床数据。本研究利用国家医院癌症数据库，评估局部治疗在尿道癌患者中的作用。
我们对 2004 年至 2013 年间诊断为 T0-4N0-2M0 期尿道癌的患者进行了回顾性队列研究。局部治疗包括放疗（RT）、手术（S）或 S+RT。采用 Cox 比例风险模型评估治疗方式对总生存（主要终点）的影响。同时，我们进行了疾病范围（早期[T0-2N0] vs 局部晚期[T3+或 N+]）和组织学亚组分析。
在本研究中，2614 例患者的中位随访时间为 28 个月。3 年总生存率为 54%。在 501 例局部晚期疾病患者中，S+RT 较 S 单独治疗的生存获益更优（风险比[HR]0.58；95%置信区间[CI]，0.42-0.80）。不同治疗方式在鳞状细胞癌患者中无差异，但腺癌（RT 对比 S：HR 0.20；95%CI，0.07-0.60）或移行细胞癌（S+RT 对比 S：HR 0.45，95%CI，0.26-0.77）患者中，RT 联合治疗可改善总生存。在 1705 例早期疾病患者中，S+RT 对比 S 的生存获益无显著差异。
对于接受 S 治疗的局部晚期疾病和移行细胞癌患者，加用 RT 可改善总体生存，应考虑采用该方案。对于腺癌患者，RT 为基础的治疗方法可能更为合适，但鳞状细胞癌患者的生存获益与治疗方式无明显相关性。本研究旨在提出假说，未来需要开展前瞻性临床试验来验证。
