Fischer-Valuck Benjamin W, Michalski Jeff M, Contreras Jessika A, Brenneman Randall, Christodouleas John P, Abraham Christopher D, Kim Eric H, Arora Vivek K, Bullock Arnold D, Carmona Ruben, Figenshau Robert S, Grubb Robert, Knoche Eric M, Pachynski Russell K, Picus Joel, Roth Bruce J, Sargos Paul, Andriole Gerald L, Gay Hiram A, Baumann Brian C
Washington University in St. Louis, Department of Radiation Oncology, St. Louis, MO, United States.
Emory University, Winship Cancer Institute, Department of Radiation Oncology, Atlanta, GA, United States.
Clin Transl Radiat Oncol. 2018 Dec 12;15:38-41. doi: 10.1016/j.ctro.2018.12.001. eCollection 2019 Feb.
Squamous cell carcinoma (SqCC) is the second most common histology of primary bladder cancer, but still very limited information is known about its treatment outcomes. Most bladder cancer trials have excluded SqCC, and the current treatment paradigm for localized SqCC is extrapolated from results in urothelial carcinoma (UC). In particular, there is limited data on the efficacy of definitive chemo-radiotherapy (CRT). In this study, we compare overall survival outcomes between SqCC and UC patients treated with definitive CRT.
MATERIALS/METHODS: We queried the National Cancer Database (NCDB) for muscle-invasive (cT2-T4 N0 M0) bladder cancer patients diagnosed from 2004 to 2013 who underwent concurrent CRT. Propensity matching was performed to match patients with SqCC to those with UC. OS was analyzed using the Kaplan-Meier survival method, and the log-rank test and Cox regression were used for analyses.
3332 patients met inclusion criteria of which 79 (2.3%) had SqCC. 73.4% of SqCC patients had clinical T2 disease compared to 82.5% of UC patients. Unadjusted median OS for SqCC patients was 15.6 months (95% CI, 11.7-19.6) versus 29.1 months (95% CI, 27.5-30.7) for those with UC (P < 0.0001). On multivariable analysis, factors associated with worse OS included: SqCC histology [HR: 1.53 (95% CI, 1.19-1.97); P = 0.001], increasing age [HR: 1.02 (95% CI, 1.02-1.03); P < 0.0001], increasing clinical T-stage [HR: 1.21 (95% CI, 1.13-1.29); P < 0.0001], and Charlson-Deyo comorbidity index [HR: 1.26 (95% CI, 1.18-1.33); P < 0.0001]. Seventy-seven SqCC patients were included in the propensity-matched analysis (154 total patients) with a median OS for SqCC patients of 15.1 months (95% CI, 11.1-18.9) vs. 30.4 months (95% CI, 19.4-41.4) for patients with UC (P = 0.013).
This is the largest study to-date assessing survival outcomes for SqCC of the bladder treated with CRT. In this study, SqCC had worse overall survival compared to UC patients. Histology had a greater impact on survival than increasing T-stage, suggesting that histology should be an important factor when determining a patient's treatment strategy and that treatment intensification in this subgroup may be warranted.
鳞状细胞癌（SqCC）是原发性膀胱癌中第二常见的组织学类型，但关于其治疗结果的信息仍然非常有限。大多数膀胱癌试验都排除了SqCC，目前局部SqCC的治疗模式是从尿路上皮癌（UC）的结果推断而来。特别是，关于确定性放化疗（CRT）疗效的数据有限。在本研究中，我们比较了接受确定性CRT治疗的SqCC和UC患者的总生存结果。
材料/方法：我们查询了国家癌症数据库（NCDB）中2004年至2013年诊断为肌层浸润性（cT2-T4 N0 M0）膀胱癌并接受同步CRT的患者。进行倾向匹配以将SqCC患者与UC患者匹配。使用Kaplan-Meier生存方法分析总生存期，并使用对数秩检验和Cox回归进行分析。
3332例患者符合纳入标准，其中79例（2.3%）为SqCC。73.4%的SqCC患者有临床T2期疾病，而UC患者为82.5%。SqCC患者未经调整的中位总生存期为15.6个月（95%CI，11.7-19.6），而UC患者为29.1个月（95%CI，27.5-30.7）（P<0.0001）。在多变量分析中，与总生存期较差相关的因素包括：SqCC组织学类型[风险比（HR）：1.53（95%CI，1.19-1.97）；P=0.001]、年龄增加[HR：1.02（95%CI，1.02-1.03）；P<0.0001]、临床T分期增加[HR：1.21（95%CI，1.13-1.29）；P<0.0001]以及Charlson-Deyo合并症指数[HR：1.26（95%CI，1.18-1.33）；P<0.0001]。77例SqCC患者纳入倾向匹配分析（共154例患者），SqCC患者的中位总生存期为15.1个月（95%CI，11.1-18.9），而UC患者为30.4个月（95%CI，19.4-41.4）（P=0.013）。
这是迄今为止评估接受CRT治疗的膀胱SqCC生存结果的最大规模研究。在本研究中，SqCC患者的总生存期比UC患者差。组织学类型对生存的影响大于T分期增加，这表明组织学类型在确定患者治疗策略时应是一个重要因素，并且该亚组患者可能需要强化治疗。
