Department of Urology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein / Utrecht, The Netherlands.
World J Urol. 2022 Jun;40(6):1469-1479. doi: 10.1007/s00345-022-03987-4. Epub 2022 Apr 10.
Population-based studies on treatment patterns in oncology and corresponding clinical outcomes can help identify strategies towards optimal value for patients. This study was performed to describe the variation in treatment patterns and major oncological outcomes for muscle-invasive or metastatic bladder cancer (MIBC/mBC) patients in the Netherlands.
Patients diagnosed with cT2-4aN0-3M0-1 disease between 2008 and 2016 in seven large teaching hospitals in the Netherlands were included. Baseline characteristics, disease stage, intended and definitive treatment, and oncological outcomes were collected. Patients were categorized based on cTNM-stage: (1) cT2-4aN0M0, (2) cT2-4aN1-3M0 and (3) cT4b and/or M1.
The total study population comprised 1853 patients, of which 1303 patients were diagnosed with cT2-4aN0M0 disease. Overall, curative treatment was intended in 81% (range 74-85%, P value = 0.132). Radical cystectomy (RC) and curative radiotherapy (RTx) ranged between hospitals from 42 to 66% and 13 to 27%, respectively (P value < 0.001). For 334 patients staged cT4b and/or M1, frequencies for palliative therapy and best supportive care (no anti-cancer therapy) ranged between hospitals from 20 to 54% and 44 to 71%, respectively (P value < 0.001). There was no association between hospital site and overall survival (OS) in a univariable and multivariable Cox regression for survival analysis (after adjusting for age and cT-stage), for all three cTNM-groups. Neoadjuvant or induction chemotherapy (NAIC) utilization rates before RC ranged from 8 to 38% (P value < 0.001).
There is large inter-hospital variation in treatment intent in MIBC/mBC patients. This variation does not seem to translate to differences in overall survival rates. There is an ongoing trend of increased use of RC. Utilisation of NAIC is relatively low considering European guideline recommendations.
基于人群的肿瘤治疗模式研究及其相应的临床结局有助于确定为患者提供最佳价值的策略。本研究旨在描述荷兰肌层浸润性或转移性膀胱癌（MIBC/mBC）患者的治疗模式变化和主要肿瘤学结局。
纳入 2008 年至 2016 年间荷兰 7 家大型教学医院诊断为 cT2-4aN0-3M0-1 疾病的患者。收集基线特征、疾病分期、意向和确定性治疗以及肿瘤学结局。患者根据 cTNM 分期分为以下几类：（1）cT2-4aN0M0，（2）cT2-4aN1-3M0 和（3）cT4b 和/或 M1。
总研究人群包括 1853 名患者，其中 1303 名患者被诊断为 cT2-4aN0M0 疾病。总体而言，81%（范围为 74%-85%，P 值=0.132）的患者接受了根治性治疗。根治性膀胱切除术（RC）和根治性放疗（RTx）的医院间比例分别为 42%-66%和 13%-27%（P 值<0.001）。对于 334 例 cT4b 和/或 M1 分期的患者，姑息治疗和最佳支持治疗（无抗癌治疗）的频率在医院间分别为 20%-54%和 44%-71%（P 值<0.001）。在单变量和多变量 Cox 回归生存分析中，医院位置与所有三个 cTNM 组的总生存（OS）均无相关性（在调整年龄和 cT 分期后）。RC 前新辅助或诱导化疗（NAIC）使用率范围为 8%-38%（P 值<0.001）。
MIBC/mBC 患者的治疗意向存在较大的医院间差异。这种差异似乎并没有转化为总体生存率的差异。RC 的应用呈上升趋势。考虑到欧洲指南建议，NAIC 的利用率相对较低。
