Li Jincong, Song Yuxuan, Chen Rui, Gao Hanlin, Liu Yang, Peng Yun, Wu Jilin, Lai Shicong, Du Yiqing, Qin Caipeng, Xu Tao
Department of Urology, Peking University People's Hospital, Beijing, China.
Ann Surg Oncol. 2025 Mar 27. doi: 10.1245/s10434-025-17154-7.
To enhance urothelial carcinoma (UC) prognosis, clinicians combine surgery with intraoperative (ICT), neoadjuvant (NACT), or adjuvant chemotherapy (ACT); however, studies on their individual and combined effects vary. Furthermore, studies on the combined use of ACT and NACT are scarce.
This study aimed to assess the impact of these chemotherapy regimens on UC prognosis, particularly the effectiveness of ACT + NACT, using the Surveillance, Epidemiology, and End Results (SEER) database.
We analyzed 45,211 UC cases from 2019 to 2021, focusing on renal, ureter, bladder, prostate, and urethra UC. Cox model-adjusted survival curves and multivariable Cox regression were performed using SPSS and R software.
Compared with ACT, NACT alone did not significantly impact survival (hazard ratio [HR] 0.834, 95% confidence interval [CI] 0.392-1.774, p = 0.638), whereas ACT + NACT (HR 0.389, 95% CI 0.169-0.895, p = 0.026) and ICT + ACT + NACT (HR 0.466, 95% CI 0.246-0.883, p = 0.019) positively affected UC prognosis. However, when compared with the combination of ACT + NACT, the combination of ICT + ACT + NACT did not show a statistically significant effect (HR 1.198, 95% CI 0.427-3.362, p = 0.731). Compared with no chemotherapy, ACT reduced renal UC survival (HR 1.430, 95% CI 1.105-1.850, p = 0.007) but improved ureter (HR 0.460, 95% CI 0.232-0.915, p = 0.027) and bladder UC survival (HR 0.605, 95% CI 0.466-0.785, p < 0.001).
Prognosis after chemotherapy varied depending on different tumor locations. ACT reduced the prognosis of renal UC patients but elevated the prognosis of ureter UC and bladder UC patients. Distinct chemotherapy protocols have also yielded varying prognostic outcomes. For UC patients, the combination of ACT + NACT merits consideration in order to achieve better prognostic outcomes than the use of ACT or NACT alone. The adoption of ICT for UC patients may not be necessary.
为提高尿路上皮癌（UC）的预后，临床医生将手术与术中化疗（ICT）、新辅助化疗（NACT）或辅助化疗（ACT）相结合；然而，关于它们各自及联合使用效果的研究结果各不相同。此外，关于ACT和NACT联合使用的研究很少。
本研究旨在使用监测、流行病学和最终结果（SEER）数据库评估这些化疗方案对UC预后的影响，特别是ACT + NACT的有效性。
我们分析了2019年至2021年的45211例UC病例，重点关注肾、输尿管、膀胱、前列腺和尿道UC。使用SPSS和R软件进行Cox模型调整后的生存曲线分析和多变量Cox回归分析。
与ACT相比，单独使用NACT对生存率没有显著影响（风险比[HR] 0.834，95%置信区间[CI] 0.392 - 1.774，p = 0.638），而ACT + NACT（HR 0.389，95% CI 0.169 - 0.895，p = 0.026）和ICT + ACT + NACT（HR 0.466，95% CI 0.246 - 0.883，p = 0.019）对UC预后有积极影响。然而，与ACT + NACT联合使用相比，ICT + ACT + NACT联合使用没有显示出统计学上的显著效果（HR 1.198，95% CI 0.427 - 3.362，p = 0.731）。与未进行化疗相比，ACT降低了肾UC的生存率（HR 1.430，95% CI 1.105 - 1.850，p = 0.007），但提高了输尿管UC（HR 0.460，95% CI 0.232 - 0.915，p = 0.027）和膀胱UC的生存率（HR 0.605，95% CI 0.466 - 0.785，p < 0.001）。
化疗后的预后因肿瘤位置不同而异。ACT降低了肾UC患者的预后，但提高了输尿管UC和膀胱UC患者的预后。不同的化疗方案也产生了不同的预后结果。对于UC患者，为了获得比单独使用ACT或NACT更好的预后结果，ACT + NACT联合使用值得考虑。对UC患者采用ICT可能没有必要。
