Miller School of Medicine, Department of Urology, University of Miami, Miami, FL, USA -
Miller School of Medicine, Department of Public Health Sciences, University of Miami, Miami, FL, USA.
Minerva Urol Nephrol. 2021 Oct;73(5):572-580. doi: 10.23736/S2724-6051.19.03657-9. Epub 2020 Jan 30.
We compared survival outcomes among patients who received either NAC or AC and RC.
We identified patients in the National Cancer Data Base (NCDB) diagnosed with clinical T2-T4, N0, M0 urothelial carcinoma who underwent RC. Patients who received NAC were propensity matched by age, race, ethnicity, sex, insurance type, academic/research program, comorbidity, and clinical stage to patients receiving AC within 90 days of RC. Median survival was calculated using Kaplan-Meier analysis. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated from multivariable Cox regression models to compare overall survival (OS), downstaging to non-MIBC (NMIBC), and N upstaging.
A total of 417 patients treated with NAC and 272 patients treated with AC were identified from 2004-2013. Patients who received NAC had better 5-year OS (46.2%, 95% CI: 39.2-53.0%) compared to patients who received AC (37.6%, 95% CI: 31.5-43.7%). NAC was a significant predictor of decreased mortality, decreased progression to node positivity, and downstaging to NMIBC (0.76, 0.60-0.96, P=0.023; 0.19, 0.13-0.28, P<0.001; 23.96, 8.91-64.42, P<0.001).
The use of NAC+RC was associated with improved OS compared to RC+AC for patients diagnosed with T2-T4, N0, M0 bladder cancer. The increased survival benefit associated with NAC compared to AC among patients undergoing RC may be due to decreased progression to node positivity and pathological downstaging.
我们比较了接受新辅助化疗（NAC）或辅助化疗（AC）加根治性切除术（RC）的患者的生存结果。
我们在国家癌症数据库（NCDB）中确定了诊断为临床 T2-T4、N0、M0 尿路上皮癌并接受 RC 的患者。接受 NAC 的患者通过年龄、种族、民族、性别、保险类型、学术/研究项目、合并症和临床分期与接受 RC 后 90 天内接受 AC 的患者进行倾向评分匹配。采用 Kaplan-Meier 分析计算中位生存期。多变量 Cox 回归模型计算调整后的危险比（aHR）和 95%置信区间（95%CI），以比较总生存期（OS）、降期至非肌肉浸润性膀胱癌（NMIBC）和 N 分期升级。
2004 年至 2013 年期间，共确定了 417 例接受 NAC 治疗和 272 例接受 AC 治疗的患者。接受 NAC 的患者 5 年 OS （46.2%，95%CI：39.2-53.0%）优于接受 AC 的患者（37.6%，95%CI：31.5-43.7%）。NAC 是降低死亡率、降低淋巴结阳性进展和降期至 NMIBC 的显著预测因素（0.76，0.60-0.96，P=0.023；0.19，0.13-0.28，P<0.001；23.96，8.91-64.42，P<0.001）。
与 RC+AC 相比，诊断为 T2-T4、N0、M0 膀胱癌的患者接受 NAC+RC 治疗的 OS 改善。与接受 RC 的患者接受 AC 相比，NAC 带来的生存获益增加可能是由于淋巴结阳性进展和病理降期减少。
