Department of Urology, Houston Methodist Hospital, Houston, TX.
Center for Health Data Science and Analytics, Houston Methodist Hospital, Houston, TX.
Urol Oncol. 2024 Sep;42(9):291.e13-291.e25. doi: 10.1016/j.urolonc.2024.04.006. Epub 2024 May 19.
First-line systemic therapy for metastatic urothelial carcinoma of the bladder (mUC) consists of platinum-based chemotherapy in most patients and PD1/L1 inhibitors in selected patients. Multiple combination chemoimmunotherapy trials failed to show a clear benefit over chemotherapy alone. We used real-world data to evaluate clinical and sociodemographic factors associated with receipt of first-line chemotherapy, immunotherapy, or combination chemoimmunotherapy treatment for metastatic bladder cancer and examined differences in overall survival (OS).
We used the National Cancer Database to identify patients with stage IV mUC diagnosed between 2014 and 2018, who were treated with first-line immunotherapy, chemotherapy, or combination treatment. We performed multivariable logistic regression modeling to determine factors associated with treatment receipt Adjusted Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression were used to evaluate the association between treatment and OS.
In our cohort of 4,169 patients, multivariable analysis identified increasing age (RRR: 1.07, 95%CI, 1.06-1.08) and comorbidity burden (, as independent predictors of receiving immunotherapy. Treatment at an academic facility was associated with increased likelihood of combination treatment (RRR: 1.29, 95%CI, 1.01-1.65). After IPTW, we found that combination therapy (hazard ratio [HR]: 0.72; 95%CI, 0.62-0.83) was associated with improved survival compared to chemotherapy.
Patients with older age and more comorbidities were more likely to receive immunotherapy than chemotherapy for first-line treatment of metastatic urothelial carcinoma of the bladder. Utilization of chemoimmunotherapy was observed to be higher in academic centers and was associated with improved survival compared to chemotherapy.
转移性膀胱癌（mUC）的一线全身治疗包括大多数患者的铂类化疗和部分患者的 PD1/L1 抑制剂。多项联合化疗免疫治疗试验未能显示出与单独化疗相比有明确获益。我们使用真实世界数据来评估与转移性膀胱癌一线化疗、免疫治疗或联合化疗治疗相关的临床和社会人口统计学因素，并检查总生存（OS）的差异。
我们使用国家癌症数据库（National Cancer Database）确定了 2014 年至 2018 年间诊断为 IV 期 mUC 且接受一线免疫治疗、化疗或联合治疗的患者。我们进行了多变量逻辑回归模型分析以确定与治疗相关的因素。调整后的 Kaplan-Meier 生存分析和多变量 Cox 比例风险回归用于评估治疗与 OS 之间的关联。
在我们的 4169 名患者队列中，多变量分析确定年龄增长（RRR：1.07，95%CI，1.06-1.08）和合并症负担是接受免疫治疗的独立预测因素。在学术机构治疗与联合治疗的可能性增加相关（RRR：1.29，95%CI，1.01-1.65）。在 IPTW 后，我们发现与化疗相比，联合治疗（风险比 [HR]：0.72；95%CI，0.62-0.83）与改善的生存相关。
与化疗相比，年龄较大和合并症较多的患者更有可能接受免疫治疗作为转移性膀胱癌的一线治疗。在学术中心，观察到化疗免疫治疗的利用率更高，与化疗相比与生存改善相关。
