Trends in the use of perioperative chemotherapy for localized and locally advanced muscle-invasive bladder cancer: a sign of changing tides.
Trends in the use of perioperative chemotherapy for localized and locally advanced muscle-invasive bladder cancer: a sign of changing tides.
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DOI：
10.1016/j.eururo.2014.01.009
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发表时间：
2015-01
期刊：
影响因子：
23.4
通讯作者：
Cookson, Michael S.
中科院分区：
文献类型：
--
作者：
Reardon, Zachary D.;Patel, Sanjay G.;Zaid, Harras B.;Stimson, C. J.;Resnick, Matthew J.;Keegan, Kirk A.;Barocas, Daniel A.;Chang, Sam S.;Cookson, Michael S.
尽管新辅助化疗（NAC）和辅助化疗（AC）有文献记载，但在肌肉浸润性膀胱癌（MIBC）患者中使用围手术期化疗（POC）的指南推荐采用缓慢。在一个具有代表性的MIBC患者队列中评估POC使用的时间趋势，并确定影响POC递送的因素。回顾性队列研究确定与POC接收相关的因素，并评估NAC和AC利用率的时间变化。我们纳入了来自国家癌症数据库（NCDB）的既往无恶性肿瘤的患者，这些患者在2006年至2010年间因≥cT2/cN0/cM0的MIBC最终接受了根治性膀胱切除术。采用Pearson卡方检验和Wilcoxon秩和检验以及多变量logistic回归评估人口统计学和医院因素与接受POC可能性之间的关系。采用线性趋势检验检测NAC和AC使用的时间变化。共有5692名患者符合我们的纳入标准。POC的使用从2006年的29.5%增加到2010年的39.8% （p < 0.001）。NAC的使用从2006年的10.1%增加到2010年的20.8% (p = 0.005)；AC稳定在18.1% ~ 21.3%之间（p = 0.68）。多变量模型显示，老年、合病增加、缺乏保险、旅行距离增加、美国东北部以外的地理位置和较低的收入与POC收入呈负相关（均p < 0.05）。局限性包括回顾性设计和潜在的抽样偏倚，排除了在非ncdb设施治疗的患者。从2006年到2010年，MIBC的POC使用量增加了，由于NAC利用率的增加，这种增加不成比例。然而，继发于非临床因素的POC的可能性存在持续变化。当回顾性分析2006年至2010年间接受根治性膀胱切除术的肌肉浸润性膀胱癌患者的代表性队列时，我们注意到术前化疗率稳步上升，而术后化疗的使用保持稳定。与获得护理相关的因素显著影响化疗的接受。
Despite the documented survival benefit conferred by neoadjuvant (NAC) and adjuvant chemotherapy (AC), there has been a slow adoption of guideline recommendations for the use of perioperative chemotherapy (POC) in patients with muscle-invasive bladder cancer (MIBC). To evaluate temporal trends in POC utilization and identify factors influencing POC delivery in a representative cohort of patients with MIBC. Retrospective cohort study identifying factors associated with receipt of POC and evaluating temporal changes in NAC and AC utilization. We included patients from the National Cancer Data Base (NCDB) with no prior malignancy who ultimately underwent radical cystectomy for ≥cT2/cN0/cM0 MIBC between 2006 and 2010. Relationships between demographic and hospital factors and the likelihood of receiving POC were evaluated using Pearson chi-square and Wilcoxon rank-sum tests, and multivariable logistic regression. Temporal changes in NAC and AC use were detected using a linear test of trend. A total of 5692 patients met our inclusion criteria. POC use increased from 29.5% in 2006 to 39.8% in 2010 (p < 0.001). NAC use increased from 10.1% in 2006 to 20.8% in 2010 (p = 0.005); AC remained stable between 18.1% and 21.3% (p = 0.68). Multivariable modeling revealed advanced age, increasing comorbidity, lack of insurance, increased travel distance, geographic location outside the northeastern United States, and lower income as negatively associated with POC receipt (all p < 0.05). Limitations include retrospective design and potential sampling bias, excluding patients treated at non-NCDB facilities. POC use for MIBC increased from 2006 to 2010, with this increase disproportionately due to rising NAC utilization. Nonetheless, there is persistent variation in the likelihood of receiving POC secondary to nonclinical factors. When retrospectively analyzing a representative cohort of patients undergoing radical cystectomy for muscle-invasive bladder cancer between 2006 and 2010, we noted that preoperative chemotherapy rates increased steadily while use of chemotherapy after surgery remained stable. Factors related to access to care significantly influenced receipt of chemotherapy.
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DOI：
10.1016/j.urolonc.2009.03.021
发表时间：
2011-05-01
影响因子：
2.7
作者：
Porter, Michael P.;Kerrigan, Matthew C.;Ramsey, Scott D.
通讯作者：
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影响因子：
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作者：
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作者：
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作者：
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通讯作者：
Frank, Igor
影响因子：
158.5
作者：
Grossman, HB;Natale, RB;Crawford, ED
通讯作者：
Crawford, ED