Contemporary Use of Perioperative Cisplatin-Based Chemotherapy in Patients With Muscle-Invasive Bladder Cancer
Contemporary Use of Perioperative Cisplatin-Based Chemotherapy in Patients With Muscle-Invasive Bladder Cancer
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DOI：
10.1002/cncr.25429
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发表时间：
2011-01-15
期刊：
影响因子：
6.2
通讯作者：
Frenkel, Eugene
中科院分区：
文献类型：
--
作者：
Raj, Ganesh V.;Karavadia, Saumil;Frenkel, Eugene
背景：一级证据表明，新辅助顺铂化疗联合根治性膀胱切除术（RC）可显著提高肌肉浸润性膀胱癌患者的生存优势。尽管如此，新辅助化疗并不统一使用。我们的目的是在一个三级医疗中心的当代队列中确定接受RC治疗的肌肉浸润性膀胱癌患者新辅助化疗的使用模式。方法：回顾性分析2003年至2008年在我院行膀胱切除术的膀胱癌患者。记录临床分期、病理分期、肾功能及围手术期化疗情况。主要结局指标是符合条件的患者中新辅助化疗的类型和使用情况。次要指标是辅助化疗的使用模式、肾功能、病理结果、疾病特异性和总生存期。不使用化疗的原因也进行了检查。结果：238例膀胱癌行RC的患者中，145例术前临床分期>= T2。145名患者中只有17%（25名）接受了以顺铂为基础的新辅助化疗。其中97例（67%）患者肾功能正常（CrCl bb0 60 ml/min）。接受新辅助化疗的患者比未接受新辅助治疗的患者有更高的po率（29% vs 8%）。高龄患者、合并症、对化疗毒性的担忧以及新辅助化疗的适度获益可以解释为什么不经常使用这种治疗。结论：尽管有一级证据，新辅助顺铂化疗在膀胱癌的治疗中仍然未得到充分利用，即使在高容量三级中心也是如此。一项前瞻性的评估管理选择，包括患者和医生的因素涉及使用围手术期顺铂为基础的化疗膀胱癌，指出。癌症2011;117:276 - 82。(C) 2010年美国癌症协会。
BACKGROUND: Level I evidence indicates that neoadjuvant cisplatin-based chemotherapy, in combination with radical cystectomy (RC), is associated with a significant survival advantage for patients with muscle-invasive bladder cancer. Despite this, neoadjuvant chemotherapy is not uniformly used. Our objective was to determine the patterns of utilization of neoadjuvant chemotherapy in patients undergoing RC for muscle invasive bladder cancer in a contemporary cohort in a tertiary care center. METHODS: A retrospective review was performed of patients with bladder cancer who underwent RC between 2003 and 2008 at our institution. Clinical stage, pathologic stage, renal function, and perioperative chemotherapy treatments were tabulated. Primary outcome measures were the type and use of neoadjuvant chemotherapy among eligible patients. Secondary measures were the utilization patterns of adjuvant chemotherapy, renal function, pathologic outcomes, and disease specific and overall survival. Reasons for nonutilization of chemotherapy were also examined. RESULTS: Among 238 patients who underwent RC for bladder cancer, 145 had a preoperative clinical stage >= T2. Only 17% (25 of 145) of these patients received cisplatin-based neoadjuvant chemotherapy. The renal function was adequate (CrCl > 60 ml/min) in 97 (67%) of these patients. Patients who received neoadjuvant chemotherapy had higher po rates (29% vs 8%) than patients who did not receive neoadjuvant therapy. Advanced patient age, comorbidities, concerns over toxicity of chemotherapy, and the modest nature of benefit from neoadjuvant chemotherapy may explain why this treatment is not often used. CONCLUSIONS: Despite level I evidence, neoadjuvant cisplatin-based chemotherapies continue to be underutilized in the management of bladder cancer, even at a high-volume tertiary center. A prospective evaluation of management choices, including the patient and physician factors involved in the use of perioperative cisplatin-based chemotherapy in bladder cancer, is indicated. Cancer 2011; 117:276-82. (C) 2010 American Cancer Society.