Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Urology. 2021 Aug;154:208-214. doi: 10.1016/j.urology.2021.03.033. Epub 2021 Apr 20.
To characterize the presentation, patterns of care, and outcomes of radiation-associated muscle-invasive bladder cancer (RA-MIBC) compared to primary (non-radiation associated) MIBC. RA-MIBC has been suggested to represent a more aggressive disease variant and be more difficult to treat compared to primary (non-radiation associated) MIBC.
We identified 60,090 patients diagnosed with MIBC between 1988-2015 using the Surveillance, Epidemiology, and End Results database and stratified patients based on whether radiation had been administered to a prior pelvic primary cancer. We used Fine-Gray competing risks regression to compare adjusted bladder cancer-specific mortality (BCSM) for RA-MIBC compared to primary MIBC.
There were 1,093 patients with RA-MIBC and 58,997 patients with primary MIBC. RA-MIBCs were more likely to be T4 at diagnosis (21.0% vs 17.3%, P < .001), and less likely to be node-positive (10.3% vs 17.1%, P < .001). The rate of 5-year BCSM was significantly higher for patients with RA-MIBC vs primary MIBC (56.1% vs 35.3%, AHR 1.24, P < .001), even after stratification by other tumor, treatment and patient-specific factors.
RA-MIBCs tended to present with higher grade and T stage disease and were less likely to receive curative treatment. Even when accounting for stage, grade, and receipt of treatment, patients with RA-MIBC had worse survival compared to those with primary MIBC. These findings suggest that RA-MIBC present unique clinical challenges and may also represent a biologically more aggressive disease compared to primary MIBC. Future research is needed to better understand the biology of RA-MIBC and develop improved treatment approaches.
描述与放射相关的肌层浸润性膀胱癌（RA-MIBC）与原发性（非放射相关）MIBC 的临床表现、治疗模式和结局。有人认为 RA-MIBC 是一种侵袭性更强、更难治疗的疾病变体，与原发性（非放射相关）MIBC 相比。
我们使用监测、流行病学和最终结果数据库，在 1988 年至 2015 年间确定了 60090 例 MIBC 患者，并根据先前盆腔原发性癌症是否接受放射治疗对患者进行分层。我们使用 Fine-Gray 竞争风险回归比较 RA-MIBC 与原发性 MIBC 的调整后的膀胱癌特异性死亡率（BCSM）。
共有 1093 例 RA-MIBC 和 58997 例原发性 MIBC。RA-MIBC 更有可能在诊断时为 T4（21.0%比 17.3%，P<0.001），而淋巴结阳性的可能性较小（10.3%比 17.1%，P<0.001）。RA-MIBC 患者的 5 年 BCSM 率明显高于原发性 MIBC 患者（56.1%比 35.3%，AHR 1.24，P<0.001），即使在按其他肿瘤、治疗和患者特征分层后也是如此。
RA-MIBC 倾向于表现出更高的分级和 T 分期疾病，且不太可能接受治愈性治疗。即使考虑到分期、分级和治疗的接受情况，与原发性 MIBC 患者相比，RA-MIBC 患者的生存情况仍较差。这些发现表明 RA-MIBC 存在独特的临床挑战，与原发性 MIBC 相比，可能也代表了一种生物学上更具侵袭性的疾病。需要进一步研究以更好地了解 RA-MIBC 的生物学特性，并开发出更好的治疗方法。
