新辅助化疗与辅助化疗在非转移性局部晚期根治性膀胱切除术患者中的比较。

Neoadjuvant Versus Adjuvant Chemotherapy in Non-Metastatic Locally-Advanced Stage Radical Cystectomy Candidates.

机构信息

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.

出版信息

Clin Genitourin Cancer. 2024 Oct;22(5):102132. doi: 10.1016/j.clgc.2024.102132. Epub 2024 May 31.

DOI:10.1016/j.clgc.2024.102132

PMID:38972785

Abstract

INTRODUCTION

Administration of chemotherapy before radical cystectomy (RC) in neoadjuvant setting (NAC) or after RC in adjuvant setting (ADJ) are both associated with a survival benefit relative to RC alone. However, no study directly compared the magnitude of such benefit associated with NAC versus ADJ in locally-advanced UCUB patients (T3-T4N0M0). We addressed this knowledge gap.

METHODS

Within the Surveillance, Epidemiology, and End Results database (2007-2020), we identified T3-T4N0M0 UCUB patients who underwent NAC+RC or RC+ADJ. Cumulative incidence plots and multivariable competing risks regression (CRR) models were fitted. The same methodology was then re-applied in T3 and then T4 patient subgroups.

RESULTS

Of 875 assessable patients, 603 harbored T3 stage (69.0%) and 272 harbored T4 stage (31.0%). Of all 875, 563 (64.0%) underwent RC+ADJ versus 312 (36.0%) NAC+RC. NAC+RC rates increased over time (EAPC=+6.1%, P = .001). Cumulative incidence plots derived five-year CSM rates were 40.3% in NAC+RC versus 36.1% in RC+ADJ patients (P = .2). In multivariable CRR models that also adjusted for OCM, no statistically significant difference in CSM was recorded when NAC+RC was compared to RC+ADJ (HR:0.85, P = .1). Virtually the same observations were made in subgroup analyses where CSM associated with NAC+RC was not different from that recorded in RC+ADJ (HR: 0.89 and P = .4 in T3 stage and HR:0.8 and P = .2 in T4 stage).

CONCLUSION

In locally-advanced UCUB, NAC rates have sharply increased over time. However, the approach based on neoadjuvant chemotherapy prior to RC have not resulted in a statistically significant CSM benefit relative to RC+ADJ.

摘要

简介

在新辅助治疗（NAC）或辅助治疗（ADJ）中，在根治性膀胱切除术（RC）前给予化疗，与单独 RC 相比，均与生存获益相关。然而，尚无研究直接比较 NAC 与 ADJ 对局部晚期 UCUB 患者（T3-T4N0M0）的获益程度。我们旨在填补这一知识空白。

方法

在 Surveillance, Epidemiology, and End Results 数据库（2007-2020 年）中，我们确定了接受 NAC+RC 或 RC+ADJ 的 T3-T4N0M0 UCUB 患者。绘制累积发生率图和多变量竞争风险回归（CRR）模型。然后，在 T3 患者亚组和 T4 患者亚组中应用相同的方法。

结果

在 875 例可评估患者中，603 例患者为 T3 期（69.0%），272 例患者为 T4 期（31.0%）。在所有 875 例患者中，563 例（64.0%）接受了 RC+ADJ，312 例（36.0%）接受了 NAC+RC。NAC+RC 的比例随时间增加（EAPC=+6.1%，P=.001）。从累积发生率图得出，5 年 CSS 率在 NAC+RC 组为 40.3%，在 RC+ADJ 组为 36.1%（P=.2）。在多变量 CRR 模型中，在调整了 OCM 后，NAC+RC 与 RC+ADJ 相比，CSS 无统计学差异（HR：0.85，P=.1）。在亚组分析中也观察到了几乎相同的结果，其中 NAC+RC 相关的 CSS 与 RC+ADJ 记录的 CSS 没有差异（HR：0.89，P=.4 在 T3 期和 HR：0.8，P=.2 在 T4 期）。