Department of Radiation Oncology, The University of Kansas School of Medicine, Kansas City, KS.
Am J Clin Oncol. 2019 Sep;42(9):705-710. doi: 10.1097/COC.0000000000000582.
Higher facility surgical volume predicts for improved outcomes in patients with muscle-invasive bladder cancer (MIBC) who undergo radical cystectomy. We investigated the association between facility radiotherapy (RT) case volume and overall survival (OS) for patients with MIBC who received bladder-preserving RT, and the relationship with adherence to National Comprehensive Cancer Network (NCCN) guidelines for bladder preservation.
The National Cancer Database was used to identify patients diagnosed with nonmetastatic MIBC from 2004 to 2015 and received RT at the reporting center. Facility case volume was defined as the total MIBC patients treated with RT during the period. Facilities were stratified into high-volume facility (HVF) or low-volume facility at the 80th percentile of RT case volume. OS was assessed using Kaplan-Meier analysis. Rates of compliance with NCCN guidelines regarding the use of transurethral resection of the bladder tumor before RT, planned use of concurrent chemotherapy, and total RT dose were compared. Cox proportional hazard model was used to evaluate predictors of OS.
There were 7562 patients included. No differences in age, Charlson-Deyo score, T stage, or node-positive rates were observed between groups. HVFs exhibited greater compliance with NCCN guidelines for bladder preservation (P<0.0001). Treatment at an HVF was associated with the improved OS for all patients (P=0.001) and for the subset of patients receiving NCCN-recommended RT doses (P=0.0081). Volume was an independent predictor of OS (P=0.002).
Treatment at an HVF is associated with improved OS and greater guideline-concordant management among patients with MIBC.
更高的手术设施量可预测接受根治性膀胱切除术的肌层浸润性膀胱癌（MIBC）患者的预后改善。我们调查了设施放疗（RT）病例量与接受膀胱保留 RT 的 MIBC 患者的总生存（OS）之间的关联，以及与遵守国家综合癌症网络（NCCN）膀胱保留指南之间的关系。
使用国家癌症数据库，确定了 2004 年至 2015 年间诊断为非转移性 MIBC 并在报告中心接受 RT 的患者。设施病例量定义为同期接受 RT 治疗的 MIBC 总患者数。设施按照 RT 病例量的第 80 百分位数分为高容量设施（HVF）或低容量设施。使用 Kaplan-Meier 分析评估 OS。比较 RT 前膀胱肿瘤经尿道切除术、计划使用同期化疗和总 RT 剂量使用 NCCN 指南的合规率。Cox 比例风险模型用于评估 OS 的预测因素。
共纳入 7562 例患者。两组患者在年龄、Charlson-Deyo 评分、T 分期或淋巴结阳性率方面无差异。HVF 表现出更高的遵守 NCCN 膀胱保留指南（P<0.0001）。在 HVF 治疗与所有患者的 OS 改善相关（P=0.001），也与接受 NCCN 推荐 RT 剂量的患者亚组相关（P=0.0081）。体积是 OS 的独立预测因素（P=0.002）。
在 MIBC 患者中，在 HVF 治疗与 OS 改善和更大程度的指南一致管理相关。
