膀胱癌非转移性小细胞神经内分泌癌患者的预后变量：一项基于人群的研究。

Prognostic Variables in Patients With Non-metastatic Small-cell Neuroendocrine Carcinoma of the Bladder: A Population-Based Study.

机构信息

Academic Unit of Medical Oncology, San Martino Polyclinic Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy.

出版信息

Clin Genitourin Cancer. 2019 Aug;17(4):e724-e732. doi: 10.1016/j.clgc.2019.03.010. Epub 2019 Mar 28.

DOI:10.1016/j.clgc.2019.03.010

PMID:31160193

Abstract

BACKGROUND

Small-cell carcinoma of the bladder (SCCB) is a rare, highly aggressive, neoplasm. We retrospectively analyzed the Surveillance, Epidemiology, and End Results (SEER) database to investigate the impact of chemotherapy, surgery, and radiotherapy on overall survival (OS) of patients with non-metastatic SCCB.

MATERIALS AND METHODS

The SEER Research Data (2000-2014) were reviewed using the SEER*Stat software. Patients with pure or mixed SCCB, T2-T4, any N, M0, and who received either surgery or radiotherapy with or without chemotherapy (neo-adjuvant, adjuvant, or perioperative treatment) were included. We used the Kaplan-Meier method and log-rank test for estimating survival. Cox proportional hazard regression was used to evaluate the prognostic variables.

RESULTS

A total of 384 cases of SCCB were included in the study (T2, n = 204; T3/4, n = 180), of whom 233 (60.7%) were treated with surgery, whereas 151 (39.3%) received radiotherapy. The median OS was 21.0 months (95% confidence interval [CI], 16.7-25.3 months). Age, race, chemotherapy, type of local treatment, and T and N staging were identified as independent prognostic variables (P < .05). In multivariate analysis, chemotherapy (n = 264) was associated with significant better OS (adjusted hazard ratio [HR], 0.56; 95% CI, 0.42-0.74; P < .000). Patients who underwent surgery showed longer outcome compared with those treated with radiotherapy (adjusted HR, 0.62; 95% CI, 0.47-0.82; P = .001). However, only in the T2 subgroup did surgery (n = 92) retain a significant survival difference compared with radiotherapy (n = 112) (adjusted HR, 0.37; 95% CI, 0.24-0.57; P < .000).

CONCLUSIONS

Surgery was associated with better outcome compared with radiotherapy in patients with T2 disease. Chemotherapy was associated with a longer survival in patients with non-metastatic SCCB.

摘要

背景

膀胱小细胞癌（SCCB）是一种罕见的、高度侵袭性的肿瘤。我们回顾性分析了监测、流行病学和最终结果（SEER）数据库，以研究非转移性 SCCB 患者的化疗、手术和放疗对总生存期（OS）的影响。

材料和方法

使用 SEER*Stat 软件分析了 SEER 研究数据（2000-2014 年）。纳入单纯或混合 SCCB、T2-T4、任何 N、M0 且接受手术或放疗联合或不联合化疗（新辅助、辅助或围手术期治疗）的患者。我们使用 Kaplan-Meier 方法和对数秩检验估计生存情况。Cox 比例风险回归用于评估预后变量。

结果

共纳入 384 例 SCCB 患者（T2，n=204；T3/4，n=180），其中 233 例（60.7%）接受了手术治疗，151 例（39.3%）接受了放疗。中位 OS 为 21.0 个月（95%置信区间[CI]，16.7-25.3 个月）。年龄、种族、化疗、局部治疗类型以及 T 和 N 分期被确定为独立的预后因素（P<.05）。多变量分析显示，化疗（n=264）与显著更好的 OS 相关（调整后的危险比[HR]，0.56；95%CI，0.42-0.74；P<.000）。与接受放疗的患者相比，接受手术治疗的患者的结局更长（调整后的 HR，0.62；95%CI，0.47-0.82；P=0.001）。然而，仅在 T2 亚组中，与放疗（n=112）相比，手术（n=92）保留了显著的生存差异（调整后的 HR，0.37；95%CI，0.24-0.57；P<.000）。