Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Department of Radiation Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Eur Urol Oncol. 2020 Jun;3(3):343-350. doi: 10.1016/j.euo.2018.11.010. Epub 2018 Dec 19.
Adjuvant radiation therapy (ART) after radical cystectomy (RC) for urothelial bladder cancer (UBC) may play a role in the management of muscle-invasive BC, particularly in patients with locally advanced disease and adverse pathologic features (pT3/4 or positive surgical margins [PSMs]). Evidence regarding the effect of ART on overall survival (OS) is lacking.
To evaluate national practice patterns for the use of ART and assess its impact on OS for patients with adverse pathologic features (APF) after RC.
DESIGN, SETTING, AND PARTICIPANTS: Using the National Cancer Data Base, we analyzed all UBC cases with APF after RC from 2004 to 2013. Patients were divided into ART and no-ART groups.
Relationships with oncological outcomes were analyzed using multivariable Cox regression and log-rank analyses.
Use of ART decreased during the study period from 3.1% in 2004 to 1.7% in 2013 (p=0.03). ART was administered in 1.4%, 4.0% and 5.2% of patients with pT3 UBC, pT4 UBC, and PSMs (any pT stage), respectively. The rate of ART was significantly higher among younger ages, female sex, low-volume hospitals, nonacademic community care centers, higher stages, PSMs, perioperative chemotherapy, and lymph node-positive disease. Predictors of ART receipt were PSMs (odds ratio [OR] 3.4; p<0.0001), pT4 (OR 2.6; p=0.02), community based centers (OR 2.1; p<0.0001), and female sex (OR 1.8; p<0.0001). Risk factors for worse OS included age, higher tumor stage and comorbidities, PSMs, positive nodes, and suboptimal lymph node dissection (<10 nodes removed; all p<0.001). ART was not independently associated with better OS in the full cohort (p=0.54). However, subgroup analyses suggested an OS benefit for patients with PSMs (hazard ratio 0.73; p=0.047). Limitations include the retrospective design and limited details regarding cancer-specific survival.
Use of ART for APF following RC is not common in the USA and the rate of ART has been decreasing over time. ART may have an OS benefit after RC for patients with PSMs.
In this report we looked at the outcomes for patients with locally advanced bladder cancer receiving adjuvant radiation therapy following cystectomy in a large US population. We found that adding radiation therapy after removing the bladder cancer may have some survival benefits for patients with positive surgical margins.
根治性膀胱切除术 (RC) 后辅助放疗 (ART) 可能在肌层浸润性膀胱癌 (UBC) 的治疗中发挥作用，特别是在局部晚期疾病和不良病理特征 (pT3/4 或阳性手术切缘 [PSMs]) 的患者中。关于 ART 对总生存期 (OS) 的影响的证据尚缺乏。
评估美国在 RC 后具有不良病理特征 (APF) 的患者中使用 ART 的实践模式，并评估其对 OS 的影响。
设计、设置和参与者：使用国家癌症数据库，我们分析了 2004 年至 2013 年间所有具有 APF 的 RC 后 UBC 病例。患者分为 ART 和非-ART 组。
使用多变量 Cox 回归和对数秩分析来分析与肿瘤学结局的关系。
在研究期间，ART 的使用从 2004 年的 3.1%下降到 2013 年的 1.7%（p=0.03）。pT3 UBC、pT4 UBC 和任何 pT 期 PSMs 患者中分别有 1.4%、4.0%和 5.2%接受了 ART。ART 的使用率在年龄较小、女性、低容量医院、非学术社区护理中心、较高分期、PSMs、围手术期化疗和淋巴结阳性疾病的患者中显著更高。接受 ART 的预测因素是 PSMs（优势比 [OR] 3.4；p<0.0001）、pT4（OR 2.6；p=0.02）、社区为基础的中心（OR 2.1；p<0.0001）和女性（OR 1.8；p<0.0001）。OS 较差的危险因素包括年龄、较高的肿瘤分期和合并症、PSMs、阳性淋巴结和淋巴结清扫不足（<10 个淋巴结切除；均 p<0.001）。ART 在全队列中与更好的 OS 无关（p=0.54）。然而，亚组分析表明，PSMs 患者的 OS 获益（风险比 0.73；p=0.047）。局限性包括回顾性设计和癌症特异性生存的详细信息有限。
在美国，RC 后对 APF 使用 ART 并不常见，并且 ART 的使用率随时间推移而降低。ART 可能对 PSMs 患者的 RC 后 OS 有益。
在本报告中，我们研究了在一个大型美国人群中接受膀胱切除术的局部晚期膀胱癌患者接受辅助放疗后的结局。我们发现，在切除膀胱癌后加用放疗可能对有阳性手术切缘的患者有一些生存获益。
