Garcia Cristina Cano, Tappero Stefano, Piccinelli Mattia Luca, Barletta Francesco, Incesu Reha-Baris, Morra Simone, Scheipner Lukas, Baudo Andrea, Tian Zhe, Saad Fred, Shariat Shahrokh F, Carmignani Luca, Ahyai Sascha, Longo Nicola, Tilki Derya, Briganti Alberto, De Cobelli Ottavio, Terrone Carlo, Banek Severine, Kluth Luis, Chun Felix K H, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
Goethe University Frankfurt, Department of Urology, University Hospital Frankfurt, Germany.
Can Urol Assoc J. 2023 Aug 29;17(12):E412-9. doi: 10.5489/cuaj.8442.
Despite advances in treatment, metastatic urothelial carcinoma of the urinary bladder (mUCUB) is associated with high mortality and treatment risk. We tested for regional differences in mUCUB within a large-scale, population-based database.
Using the Surveillance, Epidemiology and End Results (SEER) database (2010-2018), patient (age, sex, race/ethnicity), tumor (T-stage, N-stage, number of metastatic sites), and treatment (systemic therapy, radical cystectomy) characteristics were tabulated for mUCUB patients according to 11 SEER registries. Multinomial regression models and multivariable Cox regression models tested overall mortality (OM), adjusting for patient, tumor and treatment characteristics.
In 4817 mUCUB patients, registry-specific patient counts ranged from 1855 (38.5%) to 105 (2.2%). Important inter-regional differences existed for race/ethnicity (3-36% for others than non-Hispanic Whites), N-stage (28-39% for N1-3, 44-58% in N0, 8-22% for unknown N-stage), systemic therapy (38-54%) and radical cystectomy (3-11%). In multivariable analyses adjusting for these patient, tumor, and treatment characteristics, one registry exhibited significantly lower OM (SEER registry 10: hazard ratio [HR] 0.83) and two other registries exhibited significantly higher OM (SEER registries 9: HR 1.13; SEER registry 8: HR 1.24) relative to the largest reference registry (n=1855).
We identified important regional differences that included patient, tumor, and treatment characteristics. Even after adjustment for these characteristics, important OM differences persisted, which may warrant more detailed investigation.
尽管治疗取得了进展，但膀胱转移性尿路上皮癌（mUCUB）的死亡率和治疗风险仍然很高。我们在一个大规模的、基于人群的数据库中测试了mUCUB的区域差异。
使用监测、流行病学和最终结果（SEER）数据库（2010 - 2018年），根据11个SEER登记处，将mUCUB患者的患者（年龄、性别、种族/民族）、肿瘤（T分期、N分期、转移部位数量）和治疗（全身治疗、根治性膀胱切除术）特征制成表格。多项回归模型和多变量Cox回归模型测试了总体死亡率（OM），并对患者、肿瘤和治疗特征进行了调整。
在4817例mUCUB患者中，各登记处的患者数量从1855例（38.5%）到105例（2.2%）不等。种族/民族（非西班牙裔白人以外的占3 - 36%）、N分期（N1 - 3期占28 - 39%，N0期占44 - 58%，N分期未知占8 - 22%）、全身治疗（38 - 54%）和根治性膀胱切除术（3 - 11%）存在重要的区域差异。在对这些患者、肿瘤和治疗特征进行调整的多变量分析中，与最大的参考登记处（n = 1855）相比，一个登记处的OM显著较低（SEER登记处10：风险比[HR] 0.83），另外两个登记处的OM显著较高（SEER登记处9：HR 1.13；SEER登记处8：HR 1.24）。
我们发现了包括患者、肿瘤和治疗特征在内的重要区域差异。即使在对这些特征进行调整后，重要的OM差异仍然存在，这可能需要更详细的调查。
