2000年至2015年期间，魁北克省膀胱癌根治性膀胱切除术后的短期和长期生存率有所提高。

Short- and long-term survival has improved after radical cystectomy for bladder cancer in Québec during the years 2000-2015.

作者信息

Wissing Michel D, Santos Fabiano, Zakaria Ahmed S, O'Flaherty Ana, Tanguay Simon, Kassouf Wassim, Aprikian Armen G

机构信息

Department of Surgery, McGill University Health Centre, Montreal, Québec, Canada.

Department of Oncology, McGill University, Montreal, Québec, Canada.

出版信息

J Surg Oncol. 2019 Jun;119(8):1135-1144. doi: 10.1002/jso.25456. Epub 2019 Mar 28.

DOI:10.1002/jso.25456

PMID:30919984

Abstract

BACKGROUND AND OBJECTIVES

We evaluated the short- and long-term outcome in bladder cancer (BC) patients treated with radical cystectomy (RC) in Québec (Canada).

METHODS

Data were collected from provincial registries on all BC patients who underwent RC in Québec province in 2000-2015. Outcomes were hospitalization rates and survival. Survival analyses were conducted using log-rank tests and Cox proportional hazards models.

RESULTS

In total, 4450 patients were included in our analysis. RC was increasingly conducted by higher-volume surgeons in larger, higher-volume, academic hospitals. Comparing patients treated in 2010-2015 to 2000-2009, recently treated patients had shorter postoperative hospital stays (absolute difference, 0.9 days, P < 0.001) but also a higher readmission rate (25.0% vs 21.1% in the 30 days following discharge, P = 0.003). Overall (5-year rates 50.9% vs 42.7%, P < 0.001) and BC-specific survival (61.3% vs 55.5%, P < 0.001) had significantly improved. In multivariable analyses, overall survival was significantly better in recently treated patients (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.60-0.73), younger patients (HR, 1.16; 95% CI, 1.14-1.19), patients residing closer to the hospital (HR, 1.03; 95% CI, 1.01-1.06), and patients treated by high-volume surgeons (HR, 0.88; 95% CI, 0.82-0.94).

CONCLUSIONS

Survival in BC patients after RC has improved in recent years. Other predictors for survival are younger age, shorter distance between patients' residences and hospitals, and higher surgeon's RC loads.

摘要

背景与目的

我们评估了加拿大魁北克省接受根治性膀胱切除术（RC）的膀胱癌（BC）患者的短期和长期预后。

方法

从省级登记处收集2000 - 2015年在魁北克省接受RC的所有BC患者的数据。结局指标为住院率和生存率。使用对数秩检验和Cox比例风险模型进行生存分析。

结果

我们的分析共纳入4450例患者。RC越来越多地由大型、高容量学术医院中手术量较大的外科医生进行。将2010 - 2015年治疗的患者与2000 - 2009年治疗的患者进行比较，近期治疗的患者术后住院时间较短（绝对差异为0.9天，P < 0.001），但再入院率较高（出院后30天内为25.0% vs 21.1%，P = 0.003）。总体生存率（5年率50.9% vs 42.7%，P < 0.001）和BC特异性生存率（61.3% vs 55.%, P < 0.001）均有显著提高。在多变量分析中，近期治疗的患者总体生存率显著更好（风险比[HR]，0.66；95%置信区间[CI]，0.60 - \alpha），年轻患者（HR，1.16；95% CI，1.14 - 1.19），居住距离医院较近的患者（HR，1.03；95% CI，1.01 - 1.06），以及由手术量较大的外科医生治疗的患者（HR，0.88；95% CI，0.82 - 0.94）。