The healthcare business of Merck KGaA, Darmstadt, Germany.
Health Data Insight CIC, Fulbourn, United Kingdom; NHS Digital, Leeds, United Kingdom.
Urol Oncol. 2024 Dec;42(12):451.e11-451.e18. doi: 10.1016/j.urolonc.2024.07.010. Epub 2024 Jul 28.
Systemic anticancer therapy for locally advanced or metastatic urothelial carcinoma (la/mUC) is associated with efficacy benefits, including longer overall survival (OS), but many patients remain untreated. This observational, real-world, national study aimed to investigate factors associated with receiving systemic anticancer therapy for la/mUC in England.
Adults diagnosed with la/mUC between 2013 and 2019 were identified in the National Cancer Registration Dataset and followed until March 2021. Healthcare and comorbidity data were obtained from Hospital Episode Statistics Admitted Patient Care and Outpatient datasets. Treatment data were obtained from the Systemic Anti-Cancer Therapy dataset. Factors associated with treatment were identified using multivariable logistic regression. OS from la/mUC diagnosis was estimated using Kaplan-Meier methodology.
Of 16,610 patients diagnosed with la/mUC, 5,191 (31%) received systemic anticancer therapy; 4,700 (91%) received platinum-based chemotherapy. Only 18% of patients were cisplatin ineligible. Patients were significantly less likely to receive treatment if they were female, cisplatin ineligible, older, or diagnosed before 2018; had laUC, an Eastern Cooperative Oncology Group performance status >1, or greater comorbidity; or resided outside London or in income-deprived areas. Median OS (95% CI) from diagnosis in treated vs. untreated patients was 19.9 (19.4-20.6) vs. 5.8 (5.6-6.0) months, respectively. Limitations include retrospective analysis of data not initially collected for research purposes.
From 2013 to 2019, ≈70% of patients with la/mUC in England were untreated, which is high given the availability of effective treatments. Reasons for undertreatment should be addressed. Given the evolving treatment landscape, analysis of more recent data would be informative.
This study investigated systemic anticancer treatment for patients diagnosed with advanced urothelial carcinoma in England between 2013 and 2019. Of 16,610 patients, 31% received treatment. Various factors were associated with not receiving treatment, including female sex, older age, worse performance status, greater comorbidity, and resident in income-deprived areas. Median overall survival in treated vs. untreated patients was 19.9 vs. 5.8 months.
全身性抗癌疗法在局部晚期或转移性尿路上皮癌（la/mUC）中的应用与疗效益处相关，包括更长的总生存期（OS），但许多患者仍未接受治疗。这项观察性、真实世界、全国性研究旨在调查英国接受 la/mUC 全身性抗癌治疗的相关因素。
从国家癌症登记数据库中确定了 2013 年至 2019 年间诊断为 la/mUC 的成年人，并随访至 2021 年 3 月。从医院病例统计数据的入院患者护理和门诊数据集获取医疗保健和合并症数据。从全身抗癌治疗数据集获取治疗数据。使用多变量逻辑回归确定与治疗相关的因素。使用 Kaplan-Meier 方法估计 la/mUC 诊断后的 OS。
在 16610 例诊断为 la/mUC 的患者中，有 5191 例（31%）接受了全身性抗癌治疗；4700 例（91%）接受了铂类化疗。只有 18%的患者不适合使用顺铂。如果患者是女性、不适合使用顺铂、年龄较大、或在 2018 年前被诊断为患有疾病、患有局限性尿路上皮癌、东部肿瘤协作组体力状态评分>1 或合并症更多，或居住在伦敦以外或收入较低的地区，则他们接受治疗的可能性显著降低。在接受治疗和未接受治疗的患者中，从诊断开始的中位 OS（95%CI）分别为 19.9（19.4-20.6）和 5.8（5.6-6.0）个月。局限性包括对最初未为研究目的而收集的数据进行回顾性分析。
在 2013 年至 2019 年期间，英国约有 70%的 la/mUC 患者未接受治疗，鉴于有效的治疗方法，这一比例很高。应解决治疗不足的原因。鉴于治疗领域的不断发展，对最近数据的分析将具有启发性。
本研究调查了 2013 年至 2019 年间在英国诊断为晚期尿路上皮癌的患者接受全身性抗癌治疗的情况。在 16610 名患者中，有 31%接受了治疗。未接受治疗与多种因素相关，包括女性、年龄较大、体力状态评分较差、合并症更多以及居住在收入较低的地区。在接受治疗和未接受治疗的患者中，中位总生存期分别为 19.9 个月和 5.8 个月。
