Low incidence of perioperative chemotherapy for stage III bladder cancer 1998 to 2003: A report from the National Cancer Data Base
Low incidence of perioperative chemotherapy for stage III bladder cancer 1998 to 2003: A report from the National Cancer Data Base
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DOI：
10.1016/j.juro.2007.03.101
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发表时间：
2007-08-01
影响因子：
6.6
通讯作者：
Nanus, David M.
中科院分区：
文献类型：
--
作者：
David, Kevin A.;Milowsky, Matthew I.;Nanus, David M.
目的：肌层浸润性膀胱癌围手术期化疗的研究表明，综合治疗可提高患者的生存率。我们回顾了1998年至2003年的第三期膀胱移行细胞癌患者的化疗使用，以评估围手术期化疗治疗patterns.Materials和Methods：美国国家癌症数据库收集了1998年至2003年约60%的新诊断膀胱癌病例的数据。我们查询了国家癌症数据库中1998年至2003年诊断为膀胱移行细胞癌的18岁或以上男性和女性患者的所有治疗。共审查了224，060例膀胱移行细胞癌记录。围手术期化疗定义为术前4个月内和术后4个月内接受化疗。在11，339例III期膀胱癌治疗中，有7，161例可以进行分析。结果：分析了7，161例III期膀胱移行细胞癌患者的治疗模式。11.6%的III期膀胱移行细胞癌患者接受围手术期化疗，10.4%接受辅助化疗，1.2%接受新辅助化疗。当比较1998年和2003年按诊断年份划分的围手术期化疗使用情况时，采用Pearson卡方检验和Bonferroni校正，观察到有统计学意义的小幅增加（p < 0.05）1998年有11.3%的患者，2003年有16.8%。结论：围手术期化疗在可手术切除的III期膀胱移行细胞癌的治疗中应用不足。这一发现可能反映了最近报道的随机试验结果的延迟实施，泌尿科医生转诊化疗的发生率较低和/或对补救化疗作为等效替代方案的信心。进一步的随访将确定这种治疗模式在未来是否会改变。
Purpose: Studies of perioperative chemotherapy for muscle invasive bladder cancer have shown a survival benefit with combined modality therapy. We reviewed chemotherapy use in patients with stage III transitional cell carcinoma of the bladder from 1998 to 2003 to evaluate perioperative chemotherapy treatment patterns.Materials and Methods: The National Cancer Data Base collected data on approximately 60% of all newly diagnosed bladder cancer cases in the United States from 1998 to 2003. We queried the National Cancer Data Base for all treatment of male and female patients 18 years old or older with bladder transitional cell carcinoma diagnosed between 1998 and 2003. A total of 224,060 bladder transitional cell carcinoma records were reviewed. Perioperative chemotherapy was defined as chemotherapy given within 4 months before and 4 months after surgery. Of 11,339 cases of stage III bladder cancer treatment, analysis was possible for 7,161.Results: Treatment patterns were analyzed in 7,161 patients with stage III bladder transitional cell carcinoma. Perioperative chemotherapy was administered to 11.6% of patients with stage III bladder transitional cell carcinoma with 10.4% receiving adjuvant chemotherapy and 1.2% receiving neoadjuvant chemotherapy. When comparing perioperative chemotherapy use by diagnosis year in 1998 and 2003, a small statistically significant increase was observed using the Pearson's chi-square test with Bonferroni correction (p < 0.05) at 11.3% of patients in 1998 vs 16.8% in 2003.Conclusions: Perioperative chemotherapy is underused in the management of surgically resectable stage III transitional cell carcinoma of the bladder. This finding may reflect a delay in implementing the results of recently reported randomized trials, a low incidence of referrals by urologists for chemotherapy and/or confidence in salvage chemotherapy as an equivalent alternative. Further followup will determine if this treatment pattern changes in the future.