The Effect of Systemic Chemotherapy on Survival in Patients With Localized, Regional, or Metastatic Adenocarcinoma of the Urinary Bladder
The Effect of Systemic Chemotherapy on Survival in Patients With Localized, Regional, or Metastatic Adenocarcinoma of the Urinary Bladder
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DOI：
10.1097/coc.0000000000000704
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发表时间：
2020-08-01
影响因子：
2.6
通讯作者：
Karakiewicz, Pierre, I
中科院分区：
文献类型：
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作者：
Luzzago, Stefano;Palumbo, Carlotta;Karakiewicz, Pierre, I
目的：检测全身化疗对膀胱腺癌（ADKUB）患者癌症特异性死亡率（CSM）的影响。材料与方法：在监测、流行病学和最终结果登记研究（2004年至2016年）中，我们确定了局部（T2- 3 N 0 M0）、区域性（T4 N 0 M0/TanyN 1 - 3 M0）和转移性（TanyNanyM 1）ADKUB患者。在1：1倾向评分匹配和治疗加权逆概率之前和之后，使用时间趋势、Kaplan-Meier图和多变量考克斯回归模型。结果：在1537例ADKUB患者中，分别有834例（54.0%）、363例（23.5%）和340例（22.5%）存在局限性、区域性和转移性疾病。局部（估计年百分比变化[EAPC]：+2.7%;P=0.03）和区域ADKUB（EAPC：+2.4%;P=0.04）的化疗使用率增加。相反，转移性患者的化疗率保持稳定（EAPC：+1.6%;P=0.4）。在多变量考克斯回归模型中，化疗与转移性ADKUB的CSM较低相关（风险比[HR]：0.5;P=0.003），但在局部（HR：0.8;P=0.2）或区域ADKUB（HR：1.0;P=0.9）中均不相关。在转移性ADKUB中，化疗对CSM的获益在1：1倾向评分匹配（HR：0.6;P=0.002）和治疗加权逆概率（HR：0.4;P
Objectives: To test the effect of systemic chemotherapy on cancer-specific mortality (CSM) in patients with adenocarcinoma of the urinary bladder (ADKUB). Materials and Methods: Within the Surveillance, Epidemiology, and End Results registry (2004 to 2016), we identified patients with localized (T2-3N0M0), regional (T4N0M0/TanyN1-3M0), and metastatic (TanyNanyM1) ADKUB. Temporal trends, Kaplan-Meier plots, and multivariable Cox regression models were used before and after 1:1 propensity score matching and inverse probability of treatment weighting. Results: Of 1537 patients with ADKUB, 834 (54.0%), 363 (23.5%), and 340 (22.5%) harbored localized, regional, and metastatic disease, respectively. The rates of chemotherapy use increased in localized (estimated annual percentage change [EAPC]: +2.7%;P=0.03) and regional ADKUB (EAPC: +2.4%;P=0.04). Conversely, chemotherapy rates remained stable in metastatic patients (EAPC: +1.6%;P=0.4). In multivariable Cox regression models, chemotherapy use was associated with lower CSM in metastatic ADKUB (hazard ratio [HR]: 0.5;P=0.003), but not in either localized (HR: 0.8;P=0.2) or in regional ADKUB (HR: 1.0;P=0.9). In metastatic ADKUB, the benefit of chemotherapy on CSM persisted after 1:1 propensity score matching (HR: 0.6;P=0.002) and after inverse probability of treatment weighting (HR: 0.4;P