Department of Urology, Tulane University, New Orleans, LA.
Department of Urology, Tulane University, New Orleans, LA.
Clin Genitourin Cancer. 2019 Oct;17(5):380-388. doi: 10.1016/j.clgc.2019.06.010. Epub 2019 Jun 26.
The objective of this study was to characterize the demographic, prognostic, and treatment factors for patients with primary adenocarcinoma of the bladder by analyzing the impact of histologic subtype in a large sample size and interpreting newly released Surveillance, Epidemiology, and End Results (SEER) chemotherapy data.
The SEER 18 Registry was utilized to identify cases of primary adenocarcinoma diagnosed from 1973 to 2015. Demographic data, tumor and disease characteristics, treatment information, and survival outcome data were collected. Overall survival and disease-specific survival were determined using Kaplan-Meier curve analysis. Univariate and multivariate Cox regression analysis were then completed using SAS JMP.
A total of 2305 cases of primary adenocarcinoma of the bladder were identified. Overall survival at 2-, 5- and 10-year intervals was 54.8%, 36.1%, and 25.4%, respectively. Disease-specific survival at 2-, 5- and 10-year intervals was 62.0%, 47.1%, and 40.1%, respectively. Patients were treated with surgery (86.4%), chemotherapy (21.9%), and radiation (15.0%) (P < .0001). Multivariate Cox regression analysis showed independent prognostic value for gender, stage, grade, primary tumor location, and histologic subtype. The urachus/dome location conferred survival advantage over non-urachal locations on univariable and multivariable Cox regression analysis. The papillary adenocarcinoma subtype conferred the best survival outcome, whereas signet cell carcinoma (hazard ratio, 2.069; P < .0001) and unclassified adenocarcinoma (not otherwise specified) (hazard ratio, 1.524; P < .0001) conferred the worst prognoses.
This study utilized a population-based analysis to showcase the utility of various prognostic features in primary bladder adenocarcinoma cases. In characterizing treatments, we find the prevailing treatment remains surgical intervention, whereas a sizable minority receives chemotherapy and/or radiation, often in combination with surgery.
本研究旨在通过分析大样本中组织学亚型的影响，并解读新发布的监测、流行病学和最终结果（SEER）化疗数据，来描述原发性膀胱腺癌患者的人口统计学、预后和治疗因素。
利用 SEER18 注册中心，从 1973 年至 2015 年期间，确定了原发性膀胱腺癌的病例。收集了人口统计学数据、肿瘤和疾病特征、治疗信息以及生存结局数据。采用 Kaplan-Meier 曲线分析确定总生存率和疾病特异性生存率。然后使用 SAS JMP 完成单变量和多变量 Cox 回归分析。
共确定了 2305 例原发性膀胱腺癌患者。2 年、5 年和 10 年的总生存率分别为 54.8%、36.1%和 25.4%。2 年、5 年和 10 年的疾病特异性生存率分别为 62.0%、47.1%和 40.1%。患者接受了手术（86.4%）、化疗（21.9%）和放疗（15.0%）（P<.0001）。多变量 Cox 回归分析显示，性别、分期、分级、原发肿瘤位置和组织学亚型是独立的预后因素。与非脐尿管位置相比，脐尿管/穹窿位置在单变量和多变量 Cox 回归分析中具有生存优势。乳头状腺癌亚型的生存预后最好，而印戒细胞癌（危险比 2.069；P<.0001）和未分类腺癌（未特指）（危险比 1.524；P<.0001）的预后最差。
本研究利用基于人群的分析，展示了各种预后因素在原发性膀胱腺癌病例中的应用。在描述治疗方法时，我们发现主要的治疗方法仍然是手术干预，而相当一部分患者接受化疗和/或放疗，通常与手术联合应用。
