Janopaul-Naylor James Robert, Zhong Jim, Liu Yuan, Zhang Chao, Osunkoya Adeboye O, Joshi Shreyas Subhash, Bilen Mehmet Asim, Carthon Bradley, Kucuk Omer, Hartsell Lindsey Marie, Shelton Joseph, Jani Ashesh B
Department of Radiation Oncology, Emory University, United States.
Department of Biostatistics and Bioinformatics, Emory University, United States.
Clin Transl Radiat Oncol. 2020 Nov 9;26:30-34. doi: 10.1016/j.ctro.2020.11.002. eCollection 2021 Jan.
For muscle-invasive bladder cancer, bladder preserving chemoradiotherapy (BPCRT) has shown to be a viable alternative for patients with urothelial carcinoma (UCa). Traditionally bladder cancer with variant histology UCa or other tumors types involving the bladder have worse outcomes and BPCRT has been contraindicated. However, there is limited high level evidence for this recommendation.
MATERIALS/METHODS: The National Cancer Database (NCDB) was queried for all patients with Bladder cancer treated from 2004 to 2015 restricted to clinical stage T2-4, N0, M0 who had variants of UCa or other tumors types involving the bladder (e.g. adenocarcinoma and squamous cell carcinoma). Only patients treated with definitive intent with either radical cystectomy or BPCRT after maximal transurethral tumor resection were analyzed. Propensity-score matching was used.
356 patients had BPCRT and 2093 patients had definitive surgery for muscle-invasive bladder cancer limited to variants of UCa and other tumors types involving the bladder. On multivariable analysis worse prognosis was associated with age >65 years old (HR 1.24, p = 0.004) and T4 disease (HR 1.90, p < 0.001). In propensity score weighted sample, there was no statistical significant difference in OS for patients with BPCRT as compared to cystectomy (p = 0.387) and for neuroendocrine, micropapillary or not otherwise specified histology subgroups there was no significant difference. Patients with adenocarcinoma (HR 1.75) or squamous cell carcinoma (HR 1.49) had worse OS associated with BPCRT compared to surgery.
From 2004 to 2015, BPCRT in muscle-invasive bladder cancer was associated with similar overall survival compared to cystectomy in patients with selected variant histology but with worse OS for adenocarcinoma or squamous cell carcinoma specifically. As our study has inherent limitations, these hypotheses require validation in a prospective setting and/or with a larger sample size.
对于肌层浸润性膀胱癌，膀胱保留放化疗（BPCRT）已被证明是尿路上皮癌（UCa）患者的一种可行替代方案。传统上，具有组织学变异的UCa或其他累及膀胱的肿瘤类型的膀胱癌预后较差，BPCRT一直被视为禁忌。然而，这一推荐的高水平证据有限。
材料/方法：查询国家癌症数据库（NCDB）中2004年至2015年期间接受治疗的所有膀胱癌患者，限于临床分期为T2-4、N0、M0且具有UCa变异或其他累及膀胱的肿瘤类型（如腺癌和鳞状细胞癌）。仅分析在最大经尿道肿瘤切除术后接受根治性膀胱切除术或BPCRT的明确意向治疗的患者。采用倾向评分匹配法。
356例患者接受了BPCRT，2093例患者因肌层浸润性膀胱癌限于UCa变异和其他累及膀胱的肿瘤类型而接受了根治性手术。多变量分析显示，预后较差与年龄>65岁（HR 1.24，p = 0.004）和T4期疾病（HR 1.90，p < 0.001）相关。在倾向评分加权样本中，BPCRT患者与膀胱切除术患者的总生存期无统计学显著差异（p = 0.387），神经内分泌、微乳头或未另行指定组织学亚组也无显著差异。与手术相比，腺癌（HR 1.75）或鳞状细胞癌（HR 1.49）患者接受BPCRT时总生存期较差。
2004年至2015年期间，对于具有特定组织学变异的患者，肌层浸润性膀胱癌的BPCRT与膀胱切除术的总生存期相似，但腺癌或鳞状细胞癌患者的总生存期尤其较差。由于我们研究存在固有局限性，这些假设需要在前瞻性研究和/或更大样本量中进行验证。
