Utilization of Bacillus Calmette-Guerin for Nonmuscle Invasive Bladder Cancer in an Era of Bacillus Calmette-Guerin Supply Shortages
Utilization of Bacillus Calmette-Guerin for Nonmuscle Invasive Bladder Cancer in an Era of Bacillus Calmette-Guerin Supply Shortages
复制标题
DOI：
10.1016/j.urology.2018.07.055
复制
发表时间：
2019-02-01
期刊：
影响因子：
2.1
通讯作者：
Abouassaly, Robert
中科院分区：
文献类型：
--
作者：
Khanna, Abhinav;Yerram, Nitin;Abouassaly, Robert
为了研究卡介苗（BCG）利用率的非肌层浸润性膀胱癌（NMIBC）的趋势之前和国家BCG短缺期间，国家癌症数据库被用来确定与本地化NMIBC患者。采用多变量logistic回归分析评估与BCG使用相关的因素。使用分段回归分析研究了BCG使用的时间趋势。结果我们从2004年至2015年确定了238，279名NMIBC患者。总体而言，33，660例（14.1%）NMIBC患者在研究期间接受了膀胱内BCG。分段回归显示，在2011年和2012年主要供应中断后，卡介苗使用率的增长速度较慢（2004-2012年：每年增长+0.62%[P < .0001]; 2013-2015年：每年增长+0.29%[P = .084]）。这种趋势是最明显的TA-低级别的患者和最不明显的TI-高级别patients.CONCLUSIONS BCG利用NMIBC显着增加，在研究期间，可能代表增加通过国家指南BCG在NMIBC。在BCG供应中断后的几年里，BCG的使用似乎是根据临床风险进行配给的，最低风险患者的BCG使用下降最快。(C)2018爱思唯尔公司
OBJECTIVES To study trends in Bacillus Calmette-Guerin (BCG) utilization for nonmuscle invasive bladder cancer (NMIBC) before and during national BCG shortages.METHODS The National Cancer Database was used to identify patients with localized NMIBC. Multivariate logistic regression was used to assess factors associated with BCG use. Temporal trends in BCG use were studied using segmented regression analysis.RESULTS We identified 238,279 patients with NMIBC from 2004 to 2015. Overall, 33,660 (14.1%) patients with NMIBC received intravesical BCG during the study period. Segmented regression revealed a slower rate of rise of BCG utilization following major supply interruptions in 2011 and 2012 (2004-2012: +0.62% increase per year [P < .0001]; 2013-2015: +0.29% increase per year [P = .084]). This trend was most pronounced in Ta-low grade patients and least pronounced in TI-high grade patients.CONCLUSIONS BCG utilization for NMIBC increased significantly over the study period, possibly representing increased adoption of national guidelines for BCG in NMIBC. In the years following interruptions in BCG supply, BCG use appears to have been rationed based on clinical risk, with the steepest declines in BCG use occurring in the lowest risk patients. (C) 2018 Elsevier Inc.