Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gyeonggi-Do, Republic of Korea.
Department of Urology, Hyundae General Hospital, Chung-Ang University College of Medicine, Gyeonggi-Do, Republic of Korea.
Sci Rep. 2023 Mar 6;13(1):3682. doi: 10.1038/s41598-023-30356-x.
This study assessed the trends in methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) and gemcitabine-cisplatin (GC) regimens in Korean patients with metastatic urothelial carcinoma (UC) and compared the side effects and overall survival (OS) rates of the two regimens using nationwide population-based data. The data of patients diagnosed with UC between 2004 and 2016 were collected using the National Health Insurance Service database. The overall treatment trends were assessed according to the chemotherapy regimens. The MVAC and GC groups were matched by propensity scores. Cox proportional hazard analysis and Kaplan-Meier analysis were performed to assess survival. Of 3108 patients with UC, 2,880 patients were treated with GC and 228 (7.3%) were treated with MVAC. The transfusion rate and volume were similar in both the groups, but the granulocyte colony-stimulating factor (G-CSF) usage rate and number were higher in the MVAC group than in the GC group. Both groups had similar OS. Multivariate analysis revealed that the chemotherapy regimen was not a significant factor for OS. Subgroup analysis revealed that a period of ≥ 3 months from diagnosis to systemic therapy enhanced the prognostic effects of the GC regimen. The GC regimen was widely used as the first-line chemotherapy in more than 90% of our study population with metastatic UC. The MVAC regimen showed similar OS to the GC regimen but needed greater use of G-CSF. The GC regimen could be a suitable treatment option for metastatic UC after ≥ 3 months from diagnosis.
本研究评估了转移性尿路上皮癌（UC）韩国患者中甲氨蝶呤、长春碱、多柔比星和顺铂（MVAC）和吉西他滨-顺铂（GC）方案的趋势，并使用全国基于人群的数据比较了两种方案的副作用和总生存率（OS）。使用国家健康保险服务数据库收集了 2004 年至 2016 年间诊断为 UC 的患者的数据。根据化疗方案评估总体治疗趋势。MVAC 和 GC 组通过倾向评分匹配。进行 Cox 比例风险分析和 Kaplan-Meier 分析以评估生存情况。在 3108 名 UC 患者中，2880 名患者接受 GC 治疗，228 名（7.3%）患者接受 MVAC 治疗。两组的输血率和输血量相似，但 MVAC 组的粒细胞集落刺激因子（G-CSF）使用率和用量均高于 GC 组。两组的 OS 均相似。多变量分析显示，化疗方案不是 OS 的显著因素。亚组分析显示，从诊断到系统治疗的时间间隔≥3 个月增强了 GC 方案的预后效果。GC 方案作为转移性 UC 一线化疗在研究人群中超过 90%的患者中广泛应用。MVAC 方案与 GC 方案的 OS 相似，但需要更多地使用 G-CSF。GC 方案在诊断后≥3 个月可能是转移性 UC 的合适治疗选择。
