Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
Clin Genitourin Cancer. 2019 Jun;17(3):e461-e471. doi: 10.1016/j.clgc.2019.01.007. Epub 2019 Jan 19.
Clinical T1 (cT1) bladder cancer is associated with high rates of recurrence, upstaging, and progression. Guidelines recommend that these patients be treated with adjuvant intravesical Bacillus Calmette-Guérin immunotherapy (BCG) or upfront radical cystectomy (RC). We analyzed the National Cancer Database (NCDB) to identify demographic and clinical determinants of guideline-based treatment (GBT) and RC.
We identified 47,694 patients in the NCDB with cT1 bladder cancer diagnosed in 2004-2013. Those who did not receive any treatment or underwent primary chemotherapy were excluded. Mixed effects logistic regression adjusted for facility-level variation was used to identify factors associated with receipt of GBT.
The median age of the cohort was 72 years (interquartile range, 63-79). Of the patients, 22.4% were female, 5.1% were African American, and 2.7% had variant histology. Nearly one-third of patients received GBT: 11,453 (24%) were initially treated with BCG and 3320 (7%) were initially treated with RC. Recent year of diagnosis (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.52-1.85; P < .001), treatment at an academic center (OR, 2.42; 95% CI, 2.27-2.59; P < .001), and private insurance status (OR, 1.41; 95% CI, 1.19-1.66; P < .001) were associated with increased odds of GBT. Of patients who received GBT, variant histology (OR, 5.89; 95% CI, 4.65-7.47; P < .001), and recent year of diagnosis (OR, 1.89; 95% CI, 1.50-2.39; P < .001) were associated with greater odds of RC.
There is low treatment-guideline compliance for patients with cT1 disease. However, there appears to be a temporal trend toward increased use of GBT. Efforts should be made to understand why many cT1 bladder cancer patients do not receive GBT.
临床 T1（cT1）膀胱癌与高复发率、升级和进展相关。指南建议这些患者接受辅助膀胱内卡介苗免疫治疗（BCG）或初始根治性膀胱切除术（RC）。我们分析了国家癌症数据库（NCDB），以确定基于指南的治疗（GBT）和 RC 的人口统计学和临床决定因素。
我们在 NCDB 中确定了 47694 名 2004-2013 年诊断为 cT1 膀胱癌的患者，排除了未接受任何治疗或接受初始化疗的患者。使用混合效应逻辑回归调整机构水平的变异性来确定与接受 GBT 相关的因素。
队列的中位年龄为 72 岁（四分位距，63-79）。患者中，22.4%为女性，5.1%为非裔美国人，2.7%为变异型组织学。近三分之一的患者接受了 GBT：11453 名（24%）最初接受 BCG 治疗，3320 名（7%）最初接受 RC 治疗。最近的诊断年份（比值比[OR]，1.67；95%置信区间[CI]，1.52-1.85；P<0.001）、在学术中心治疗（OR，2.42；95%CI，2.27-2.59；P<0.001）和私人保险状态（OR，1.41；95%CI，1.19-1.66；P<0.001）与接受 GBT 的几率增加相关。在接受 GBT 的患者中，变异型组织学（OR，5.89；95%CI，4.65-7.47；P<0.001）和最近的诊断年份（OR，1.89；95%CI，1.50-2.39；P<0.001）与接受 RC 的几率增加相关。
cT1 疾病患者的治疗指南遵循率较低。然而，GBT 的使用似乎有增加的趋势。应努力了解为什么许多 cT1 膀胱癌患者未接受 GBT。
