Department of Urology, University of Arizona, Tucson, AZ.
Department of Medicine, University of Arizona Cancer Center, Tucson, AZ.
Urology. 2023 Aug;178:105-113. doi: 10.1016/j.urology.2023.03.053. Epub 2023 May 23.
To evaluate trends and racial variations of pathologic complete response (CR) in patients with muscle-invasive bladder cancer undergoing cystectomy.
The National Cancer Database was queried for patients with non-metastatic muscle-invasive bladder cancer who underwent neoadjuvant chemotherapy and surgery. The primary endpoints, CR and mortality, were evaluated using the Cochran-Armitage test, multivariable regression, and Kaplan-Meier analyses.
The cohort comprised 9955 patients. Non-Hispanic Black (NHB) patients were younger (P < .001), had a higher clinical tumor (P < .001), and had higher clinical node (P = .029) stages at presentation. CR for non-Hispanic White (NHW), NHB, and Hispanic patients were 12.6%, 10.1%, and 11.8%, respectively (P = .030). There was a significant increase in CR trends for NHW patients (P < .001) and increases in NHB (P = .311) and Hispanic patients (P = .236). On multivariable analysis, NHW females had lower odds of achieving CR (odds ratio: 0.83, 95% CI: 0.71-0.97); however, NHB males (hazard ratio: 1.21, 1.01-1.44) and NHB females (hazard ratio: 1.25, 1.03-1.53) had higher overall mortality in adjusted analysis. Survival differences were not observed in patients who achieved CR, regardless of racial background; however, for those with residual disease, the 2-year survival probabilities were 60.7%, 62.5%, and 51.1% for NHW, HW, and NHB patients, respectively (log-rank P = .010).
Our findings revealed differences in chemotherapy response based on gender and race or ethnicity. The CR trends for all racial or ethnic groups increased over time. However, Black patients were found to have worse survival, particularly when residual disease was present. Clinical studies with more underrepresented minorities are needed to verify biological differences in response to neoadjuvant chemotherapy.
评估接受膀胱切除术的肌层浸润性膀胱癌患者病理完全缓解（CR）的趋势和种族差异。
国家癌症数据库对接受新辅助化疗和手术的非转移性肌层浸润性膀胱癌患者进行了检索。使用 Cochran-Armitage 检验、多变量回归和 Kaplan-Meier 分析评估主要终点 CR 和死亡率。
该队列包括 9955 名患者。非西班牙裔黑人（NHB）患者更年轻（P <.001），临床肿瘤分期更高（P <.001），临床淋巴结分期更高（P =.029）。非西班牙裔白人（NHW）、NHB 和西班牙裔患者的 CR 分别为 12.6%、10.1%和 11.8%（P =.030）。NHW 患者的 CR 趋势显著增加（P <.001），NHB（P =.311）和西班牙裔患者（P =.236）的 CR 趋势也有所增加。多变量分析显示，NHW 女性获得 CR 的可能性较低（比值比：0.83，95%置信区间：0.71-0.97）；然而，NHB 男性（风险比：1.21，1.01-1.44）和 NHB 女性（风险比：1.25，1.03-1.53）在调整分析中具有更高的总死亡率。无论种族背景如何，在获得 CR 的患者中并未观察到生存差异；然而，对于有残留疾病的患者，2 年生存率分别为 NHW、HW 和 NHB 患者的 60.7%、62.5%和 51.1%（对数秩 P =.010）。
我们的研究结果表明，基于性别、种族或民族，化疗反应存在差异。所有种族或民族群体的 CR 趋势随着时间的推移而增加。然而，黑人患者的生存情况较差，尤其是当存在残留疾病时。需要开展更多代表性不足的少数族裔的临床研究，以验证对新辅助化疗反应的生物学差异。
