老年和高龄尿路上皮膀胱癌患者行根治性膀胱切除术与放疗的比较
Radical Cystectomy vs. Radiotherapy in Urothelial Bladder Cancer in Elderly and Very Elderly Patients.
作者信息
Horlemann Benedikt, Würnschimmel Christoph, Hoeh Benedikt, Sorce Gabriele, Chierigo Francesco, Flammia Rocco Simone, Tian Zhe, Saad Fred, Briganti Alberto, Shariat Sharokh F, Galucci Michele, Chun Felix K H, Graefen Markus, Karakiewicz Pierre I
机构信息
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Clin Genitourin Cancer. 2022 Feb;20(1):93.e1-93.e9. doi: 10.1016/j.clgc.2021.08.003. Epub 2021 Sep 1.
INTRODUCTION
Controversy regarding cancer-specific mortality (CSM) of elderly and very elderly patients with muscle-invasive, non-metastatic, urothelial carcinoma of the urinary bladder (UCUB) undergoing radical cystectomy (RC) vs radiotherapy (RT) still exists.
MATERIALS AND METHODS
In the 2004-2016 Surveillance, Epidemiology and End Results (SEER) database, we identified 2663 UCUB patients aged 75-79 (1808 RC vs 855 RT) and 3569 UCUB patients aged 80-89 (1551 RC vs 2018 RT). After stratification for concomitant chemotherapy, propensity score matching (PSM) between RC and RT was applied and competing-risks regression models addressed CSM and OCM.
RESULTS
In the cohort aged 75-79, five-year CSM rates were 22.0 vs 49.0% for RC only vs RT only and yielded a HR of 0.41 (95% confidence interval (CI) 0.30-0.57, p<0.001) favoring RC only. Five-year CSM rates were 28.3 vs 44.3% for RC with chemotherapy vs trimodal therapy (TMT) and yielded a HR of 0.48 (95% CI 0.35-0.65, p<0.001) favoring RC with chemotherapy. In the cohort aged 80-89, five-year CSM rates were 24.2 vs 48.9% for RC only vs RT only and yielded a HR of 0.42 (95% CI 0.33-0.52, p<0.001) favoring RC only. Five-year CSM rates were 19.6 vs 43.2% for RC with chemotherapy vs TMT and yielded a HR of 0.43 (95% CI 0.28-0.67, p<0.001) favoring RC with chemotherapy.
CONCLUSIONS
In elderly and very elderly patients, radical cystectomy is associated with virtually half the CSM rate than radiotherapy, regardless of concomitant chemotherapy administration.
引言
对于接受根治性膀胱切除术（RC）与放射治疗（RT）的老年及高龄肌肉浸润性、非转移性膀胱尿路上皮癌（UCUB）患者的癌症特异性死亡率（CSM）仍存在争议。
材料与方法
在2004 - 2016年监测、流行病学和最终结果（SEER）数据库中，我们确定了2663例年龄在75 - 79岁的UCUB患者（1808例接受RC，855例接受RT）以及3569例年龄在80 - 89岁的UCUB患者（1551例接受RC，2018例接受RT）。在对同步化疗进行分层后，对RC和RT进行倾向评分匹配（PSM），并采用竞争风险回归模型分析CSM和总体竞争性死亡率（OCM）。
结果
在75 - 79岁队列中，单纯RC组与单纯RT组的五年CSM率分别为22.0%和49.0%，支持单纯RC组的风险比（HR）为0.41（95%置信区间（CI）0.30 - 0.57，p < 0.001）。接受化疗的RC组与三联疗法（TMT）组的五年CSM率分别为28.3%和44.3%，支持接受化疗的RC组的HR为0.48（95% CI 0.35 - 0.65，p < 0.001）。在80 - 89岁队列中，单纯RC组与单纯RT组的五年CSM率分别为24.2%和48.9%，支持单纯RC组的HR为0.42（95% CI 0.33 - 0.52，p < 0.001）。接受化疗的RC组与TMT组的五年CSM率分别为19.6%和43.2%，支持接受化疗RC组的HR为0.43（95% CI 0.28 - 0.67，p < 0.001）。
结论
在老年及高龄患者中，无论是否同步进行化疗，根治性膀胱切除术的CSM率几乎是放射治疗的一半。
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