Kotha Nikhil V, Kumar Abhishek, Nelson Tyler J, Qiao Edmund M, Qian Alex S, Voora Rohith S, McKay Rana R, Rose Brent S, Stewart Tyler F
Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA; Veterans Affairs San Diego Healthcare System, San Diego, CA.
Veterans Affairs San Diego Healthcare System, San Diego, CA; Department of Radiation Oncology, Duke University, Durham, NC.
Urol Oncol. 2022 Jun;40(6):274.e1-274.e6. doi: 10.1016/j.urolonc.2022.01.010. Epub 2022 Feb 23.
The coronavirus disease 2019 (COVID-19) pandemic has raised concerns about delaying treatment for localized cancer and its impact on long-term outcomes.
We aimed to investigate the impact of time to chemoradiation (CRT) on recurrence and survival outcomes for patients with muscle-invasive bladder cancer (MIBC).
In the national Veterans Affairs' database, we identified patients with urothelial histology, MIBC (T2-4a/N0-3/M0) diagnosed between 2000 to 2018 and treated with definitive CRT. Time to treatment was defined as the number of days between date of diagnosis and start date of CRT. The cohort was stratified into < 90 (early) or ≥ 90 days (delayed) groups. Endpoints of locoregional failure (LRF), distant failure (DF), overall survival (OS), and bladder cancer-specific survival (BCS) were evaluated in multivariable Cox and Fine-Gray models.
305 patients with MIBC underwent CRT - 190 (62.3%) received early CRT, 115 (37.7%) received delayed CRT. Multivariable analysis (including success of transurethral resection of bladder tumor and type of chemotherapy) revealed no difference in recurrence between groups - LRF HR 1.12 (95%CI 0.76-1.67, P = 0.56) and DF HR 1.03 (95%CI 0.70-1.53, P = 0.88). Similarly, there were no differences in survival outcomes. The lack of association was maintained at both earlier and later time cutoffs (60-120 days).
Our findings suggest that a short-term delay in definitive therapy may not affect long-term outcomes for patients with MIBC undergoing CRT. This study does not endorse delays in therapy, but rather provides information to aid patients and clinicians navigate the unique challenges of MIBC care in both pandemic and non-pandemic times.
2019年冠状病毒病（COVID-19）大流行引发了人们对局部癌症治疗延迟及其对长期预后影响的担忧。
我们旨在研究肌肉浸润性膀胱癌（MIBC）患者接受放化疗（CRT）的时间对复发和生存结局的影响。
在国家退伍军人事务数据库中，我们确定了2000年至2018年间诊断为尿路上皮组织学、MIBC（T2-4a/N0-3/M0）并接受确定性CRT治疗的患者。治疗时间定义为诊断日期与CRT开始日期之间的天数。该队列被分为<90天（早期）或≥90天（延迟）组。在多变量Cox模型和Fine-Gray模型中评估局部区域失败（LRF）、远处失败（DF）、总生存（OS）和膀胱癌特异性生存（BCS）的终点。
305例MIBC患者接受了CRT——190例（62.3%）接受了早期CRT，115例（37.7%）接受了延迟CRT。多变量分析（包括膀胱肿瘤经尿道切除术的成功率和化疗类型）显示两组之间复发无差异——LRF风险比为1.12（95%置信区间0.76-1.67，P = 0.56），DF风险比为1.03（95%置信区间0.70-1.53，P = 0.88）。同样，生存结局也没有差异。在较早和较晚的时间界限（60-120天），这种缺乏关联的情况都持续存在。
我们的研究结果表明，对于接受CRT的MIBC患者，确定性治疗的短期延迟可能不会影响长期预后。本研究并非支持治疗延迟，而是提供信息以帮助患者和临床医生应对在大流行和非大流行时期MIBC护理的独特挑战。
