Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy.
Clin Genitourin Cancer. 2020 Aug;18(4):e450-e456. doi: 10.1016/j.clgc.2019.12.001. Epub 2019 Dec 13.
The objective of this study was to test the effect of chemotherapy and/or radical cystectomy (RC) and/or radiotherapy (RT) on survival of patients with non-metastatic small-cell carcinoma of the urinary bladder (SCCUB).
Within the Surveillance, Epidemiology, and End Results registry (2001-2016), we identified patients with non-metastatic (T1-4, N0, M0) SCCUB. Treatment was defined as: chemotherapy alone, chemotherapy + RC, and chemotherapy + RT. Temporal trends, cumulative incidence plots, and multivariable competing risks regression models were used.
Of 595 patients with SCCUB, 230 (38.5%), 159 (27%), and 206 (34.5%) were treated with chemotherapy alone, chemotherapy + RC, and chemotherapy + RT, respectively. The rates of chemotherapy + RC increased (estimated annual percentage changes [EAPC], +5.9%; P = .002). Conversely, chemotherapy alone (EAPC, -1.7%; P = .1) and chemotherapy + RT rates decreased (EAPC: -2.2%; P = .08). Overall, 5-year cancer-specific mortality (CSM) rates were 44%, 29%, and 40% for patients treated with chemotherapy alone, chemotherapy + RC, and chemotherapy + RT, respectively (P = .004). Relative to chemotherapy alone, patients treated with chemotherapy + RC experienced lower CSM (hazard ratio, 0.5; P < .001). Conversely, patients treated with chemotherapy + RT did not exhibit any CSM benefit (hazard ratio, 0.8; P = .2), when compared with chemotherapy alone.
In contemporary patients with SCCUB with non-metastatic disease, the rates of chemotherapy + RC are increasing. Conversely, the rates of combined chemotherapy with RT and chemotherapy alone are decreasing. These patterns of treatment are in agreement with better cancer control in patients with SCCUB. In consequence, until more robust data become available, the combination of chemotherapy and RC should represent the recommended treatment strategy.
本研究旨在检验化疗和/或根治性膀胱切除术（RC）和/或放疗（RT）对非转移性小细胞膀胱癌（SCCUB）患者生存的影响。
我们在监测、流行病学和最终结果登记处（2001-2016 年）中确定了非转移性（T1-4、N0、M0）SCCUB 患者。治疗定义为：单独化疗、化疗+RC 和化疗+RT。我们使用了时间趋势、累积发生率图和多变量竞争风险回归模型。
在 595 例 SCCUB 患者中，分别有 230 例（38.5%）、159 例（27%）和 206 例（34.5%）接受了单独化疗、化疗+RC 和化疗+RT。化疗+RC 的使用率增加（估计年百分比变化[EAPC]，+5.9%；P=.002）。相反，单独化疗（EAPC，-1.7%；P=.1）和化疗+RT 的使用率下降（EAPC：-2.2%；P=.08）。总的来说，单独化疗、化疗+RC 和化疗+RT 治疗的患者 5 年癌症特异性死亡率（CSM）分别为 44%、29%和 40%（P=.004）。与单独化疗相比，接受化疗+RC 治疗的患者 CSM 更低（风险比，0.5；P<.001）。相反，与单独化疗相比，接受化疗+RT 的患者未表现出任何 CSM 获益（风险比，0.8；P=.2）。
在当代患有非转移性 SCCUB 的患者中，化疗+RC 的使用率正在增加。相反，联合化疗加 RT 和单独化疗的使用率正在下降。这些治疗模式与 SCCUB 患者的癌症控制效果改善一致。因此，在更可靠的数据出现之前，化疗联合 RC 应作为推荐的治疗策略。
