University of Toronto, Toronto, ON, Canada.
Vanderbilt University, Nashville, TN, USA.
Cancer Med. 2021 Apr;10(8):2636-2644. doi: 10.1002/cam4.3805. Epub 2021 Mar 12.
Utilization of neoadjuvant chemotherapy (NC) in muscle invasive bladder cancer (MIBC) is increasingly recognized as standard of care but trends of use in Ontario remain unknown. Currently, there remains knowledge gaps regarding the effects of perioperative chemotherapy on the rates of interventions requiring hospitalization (IRH) and atheroembolic events (ATEs).
We conducted a population-based retrospective study within the province of Ontario over 16 years. Patients with non-metastatic MIBC receiving surgery only or planned for perioperative chemotherapy were included. Primary outcomes included 2-year IRH and ATE rates. Univariate/multivariate analysis was used to identify predictors associated with IRHs and ATEs. Cochrane-Armitage was used to assess treatment trends over time.
Our study included 3281 patients. RC alone occurred in 2030 (60.9%), NC in 974 (29.6%) and adjuvant chemotherapy in 8.4% (n = 277). A total of 490/974 (50.3%) patients whom initiated NC with RC intent failed to undergo RC. This improved to 20.5% by 2015 (p < 0.001). Use of NC increased by an absolute value of 33% (p < 0.001). Overall, 4.2% of patients experienced IRHs and 11.5% ATEs. On multivariate analysis, advanced age and Charlson index score (CI) were strong predictors of outcomes, not timing of perioperative chemotherapy (p < 0.05.) CONCLUSION: A total of 29.6% of MIBC patients are planned for NC with 20.5% not progressing to their surgery. Use of NC has substantially increased over time. IRHs and ATEs remain stubbornly high at 4.2% and 11.5% respectively. Older age and higher CI scores are the strongest predictors of IRHs and ATEs (p < 0.05), not perioperative chemotherapy.
新辅助化疗（NC）在肌层浸润性膀胱癌（MIBC）中的应用日益被视为标准治疗方法，但安大略省的使用趋势尚不清楚。目前，关于围手术期化疗对需要住院干预（IRH）和动脉粥样栓塞事件（ATE）发生率的影响，仍存在知识空白。
我们在安大略省进行了一项基于人群的回顾性研究，时间跨度为 16 年。研究对象为接受手术治疗或计划接受围手术期化疗的非转移性 MIBC 患者。主要结局包括 2 年 IRH 和 ATE 发生率。采用单变量/多变量分析确定与 IRH 和 ATE 相关的预测因素。采用 Cochrane-Armitage 检验评估治疗趋势随时间的变化。
本研究共纳入 3281 例患者。单纯接受 RC 治疗的患者有 2030 例（62.1%），接受 NC 治疗的患者有 974 例（29.6%），接受辅助化疗的患者有 8.4%（n=277）。在计划接受 NC 联合 RC 治疗的 974 例患者中，有 490 例（50.3%）未能接受 RC 治疗。到 2015 年，这一比例降至 20.5%（p<0.001）。NC 的使用率增加了 33%（p<0.001）。总体而言，4.2%的患者发生 IRH，11.5%的患者发生 ATE。多变量分析显示，高龄和 Charlson 指数评分（CI）是结局的强预测因素，而围手术期化疗的时机则不是（p<0.05）。
29.6%的 MIBC 患者计划接受 NC 治疗，其中 20.5%的患者未接受手术治疗。NC 的使用率随着时间的推移大幅增加。IRH 和 ATE 的发生率仍分别高达 4.2%和 11.5%。高龄和更高的 CI 评分是 IRH 和 ATE 的最强预测因素（p<0.05），而不是围手术期化疗。
