种族/民族对接受放疗的尿路上皮癌患者全身化疗的影响。

The effect of race/ethnicity on systemic chemotherapy in urothelial carcinoma patients exposed to radiotherapy.

作者信息

de Angelis Mario, Siech Carolin, Di Bello Francesco, Peñaranda Natali Rodriguez, Goyal Jordan A, Tian Zhe, Longo Nicola, Chun Felix K H, Micali Salvatore, Saad Fred, Shariat Shahrokh F, Jannello Letizia Maria Ippolita, Longoni Mattia, Musi Gennaro, Gandaglia Giorgio, Moschini Marco, Montorsi Francesco, Briganti Alberto, Karakiewicz Pierre I

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, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy.

出版信息

World J Urol. 2025 Jun 30;43(1):403. doi: 10.1007/s00345-025-05767-2.

DOI:10.1007/s00345-025-05767-2

PMID:40586948

Abstract

INTRODUCTION

Based on prospective trials' result, it is unknown whether race/ethnicity affects the magnitude of cancer-specific survival differences after trimodal therapy (TMT) versus external beam radiation therapy alone (EBRT) for urothelial carcinoma for urinary bladder (UCUB). We addressed this knowledge gap.

MATERIALS AND METHODS

Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified patients with cT2-T4aN0M0 UCUB treated with either TMT or EBRT. We focused on the four most prevalent race/ethnicities: Caucasians, Hispanics, African American (AAs) and Asian/Pacific Islanders (APIs). Cumulative incidence plots and multivariable competing risks regression (CRR) models addressed cancer specific mortality (CSM) after additional adjustment for other-cause mortality (OCM) and standard covariates.

RESULTS

Of 3249 patients, 2643 (81%) were Caucasians versus 254 (8%) AAs versus 209 (7%) Hispanics versus 143 (4%) APIs. Compared to EBRT, TMT rates were higher in Caucasians (81%) and APIs (81%), lower in AAs (75%) and lowest in Hispanics (69%). In Caucasians, five-year CSM rates were 41.6% after TMT versus 49.0% after EBRT and TMT independently predicted lower CSM (HR: 0.70, p < 0.001). In AAs, Hispanics and APIs, TMT did not predict CSM differences (p = 0.1, 0.2 and p = 0.06, respectively).

CONCLUSION

For Caucasians UCUB patients, TMT is strongly associated with significantly lower CSM. However, this observation cannot be generalized non-Caucasian subgroups, where TMT did not predict lower CSM relative to EBRT.

摘要

引言

基于前瞻性试验结果，对于膀胱尿路上皮癌（UCUB），在接受三联疗法（TMT）与单纯外照射放疗（EBRT）后，种族/民族是否会影响癌症特异性生存差异的程度尚不清楚。我们填补了这一知识空白。

材料与方法

在监测、流行病学和最终结果数据库（2004 - 2020年）中，我们确定了接受TMT或EBRT治疗的cT2 - T4aN0M0 UCUB患者。我们重点关注四种最常见的种族/民族：白种人、西班牙裔、非裔美国人（AA）和亚裔/太平洋岛民（API）。累积发病率图和多变量竞争风险回归（CRR）模型在对其他原因死亡率（OCM）和标准协变量进行额外调整后，分析了癌症特异性死亡率（CSM）。

结果

在3249例患者中，2643例（81%）为白种人，254例（8%）为非裔美国人，209例（7%）为西班牙裔，143例（4%）为亚裔/太平洋岛民。与EBRT相比，TMT的比例在白种人（81%）和亚裔/太平洋岛民（81%）中较高，在非裔美国人（75%）中较低，在西班牙裔（69%）中最低。在白种人中，TMT后的五年CSM率为41.6%，而EBRT后的为49.0%，TMT独立预测较低的CSM（风险比：0.70，p < 0.001）。在非裔美国人、西班牙裔和亚裔/太平洋岛民中，TMT并未预测CSM的差异（分别为p = 0.1、0.2和p = 0.06）。