Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Department of Urology, European Institute of Oncology IRCCS, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada; Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Québec, Canada.
Clin Oncol (R Coll Radiol). 2020 Apr;32(4):e93-e101. doi: 10.1016/j.clon.2019.10.001. Epub 2019 Nov 7.
To analyse contemporary perioperative chemotherapy (CHT) guideline adherence rates for pN2-3 M0 squamous cell carcinoma of the penis, as well as CHT association with cancer-specific (CSM) and other-cause mortality (OCM).
Within the Surveillance, Epidemiology, and End Results databases, 311 pN2-3 M0 squamous cell carcinoma of the penis patients treated with inguinal lymph node dissection were identified. Univariable and multivariable logistic regression analyses focused on CHT rates, whereas cumulative incidence plots and multivariable competing risks regression analyses tested for CSM and OCM rates.
CHT was administered to 140 (45%) patients and rates increased from 37.5 to 62.2% (2004-2015; P = 0.02). Specifically, annual CHT rates increased over time in patients younger or equal to 65 years and in patients older than 65 years (44.4-84.6% versus 28.6-50%, respectively), but this trend was not statistically significant (P = 0.1 and P = 0.2, respectively). The median follow-up was 13 months for both CHT (interquartile range 8.0-32.2) and no-CHT subgroups (interquartile range 5.0-40.0). In multivariable logistic regression analyses, more contemporary year of diagnosis interval (odds ratio 2.08, P < 0.01) and age older than 75 years (odds ratio 0.14, P < 0.001) were independent predictors of CHT use. In multivariable competing risks regression analyses, CHT use did not affect CSM (hazard ratio 1.02; P = 0.7) or OCM (hazard ratio 1.56; P = 0.8).
CHT adherence rates sharply increased in the most recent years. Despite this increase over time, the lack of efficacy regarding CSM benefit is disappointing.
分析当代阴茎鳞状细胞癌 pN2-3M0 患者围手术期化疗（CHT）的指南依从率，以及 CHT 与癌症特异性（CSM）和其他原因死亡率（OCM）的关联。
在监测、流行病学和最终结果数据库中，确定了 311 例接受腹股沟淋巴结清扫术治疗的 pN2-3M0 阴茎鳞状细胞癌患者。单变量和多变量逻辑回归分析侧重于 CHT 率，而累积发病率图和多变量竞争风险回归分析则用于测试 CSM 和 OCM 率。
140 例（45%）患者接受了 CHT，并且 CHT 率从 2004 年至 2015 年从 37.5%增加到 62.2%（P=0.02）。具体而言，年龄小于或等于 65 岁的患者和年龄大于 65 岁的患者的年度 CHT 率随着时间的推移而增加（分别为 44.4-84.6%和 28.6-50%），但这一趋势无统计学意义（P=0.1 和 P=0.2）。CHT（四分位距 8.0-32.2）和无 CHT 亚组（四分位距 5.0-40.0）的中位随访时间均为 13 个月。在多变量逻辑回归分析中，更接近当代的诊断间隔年（比值比 2.08，P<0.01）和年龄大于 75 岁（比值比 0.14，P<0.001）是 CHT 使用的独立预测因素。在多变量竞争风险回归分析中，CHT 使用并未影响 CSM（危险比 1.02；P=0.7）或 OCM（危险比 1.56；P=0.8）。
最近几年 CHT 的依从率急剧上升。尽管随着时间的推移有所增加，但 CSM 获益方面缺乏疗效令人失望。
