Delivery of perioperative chemotherapy for bladder cancer in routine clinical practice
Delivery of perioperative chemotherapy for bladder cancer in routine clinical practice
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DOI：
10.1093/annonc/mdu204
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发表时间：
2014-09-01
影响因子：
50.5
通讯作者：
Mackillop, W. J.
中科院分区：
文献类型：
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作者：
Booth, C. M.;Siemens, D. R.;Mackillop, W. J.
背景：很少有文章记录了常规实践中膀胱癌围手术期化疗的方案和时机。在这里，我们描述了加拿大安大略省一般人群的实践模式。 方法：在这项回顾性队列研究中，治疗和医生账单记录与安大略省癌症登记处相关联，以描述 1994-2008 年安大略省所有接受膀胱切除术治疗的肌层浸润性膀胱癌患者中新辅助 (NACT) 和辅助 (ACT) 化疗的使用情况。从膀胱切除术测量开始 ACT (TTAC) 的时间。使用多变量 Cox 回归来确定与总生存期 (OS) 和癌症特异性生存期 (CSS) 相关的因素。 结果：在 2944 名接受膀胱切除术的患者中，分别有 4% (129/2944) 和 19% (571/2944) 接受了 NACT 和 ACT 治疗。 NACT 病例的五年 OS 为 25% [95% 置信区间 (CI) 17% 至 34%]，ACT 病例的五年 OS 为 29%（95% CI 25% 至 33%）。在可确定药物治疗方案的患者中，82% (253/308) 使用顺铂，14% (43/308) 使用卡铂。最常见的治疗方案是吉西他滨-顺铂 (54%, 166/308) 和甲氨蝶呤、长春碱、阿霉素、顺铂 (MVAC) (21%, 66/308)。平均 TTAC 为 10 周； 23% 的患者 TTAC >12 周。 TTAC > 12 周与较差的 OS [风险比 (HR) 1.28，95% CI 1.00-1.62] 和 CSS (HR 1.30，95% CI 1.00-1.69) 相关。在调整后的分析中，与接受顺铂治疗的患者相比，接受卡铂治疗的患者的 OS 和 CSS 较低； OS HR 2.14 (95% CI 1.40-3.29) 和 CSS HR 2.06 (95% CI 1.26-3.37)。结论：普通人群中的大多数患者接受顺铂治疗，这可能与优于卡铂的结局有关。开始 ACT 超过 12 周与较差的生存率相关。患者应在身体状况良好后立即开始 ACT。
Background: Few articles have documented regimens and timing of perioperative chemotherapy for bladder cancer in routine practice. Here, we describe practice patterns in the general population of Ontario, Canada.Methods: In this retrospective cohort study, treatment and physician billing records were linked to the Ontario Cancer Registry to describe use of neoadjuvant (NACT) and adjuvant (ACT) chemotherapy among all patients with muscle-invasive bladder cancer treated with cystectomy in Ontario 1994-2008. Time to initiation of ACT (TTAC) was measured from cystectomy. Multivariate Cox regression was used to identify factors associated with overall (OS) and cancer-specific survival (CSS).Results: Of 2944 patients undergoing cystectomy, 4% (129/2944) and 19% (571/2944) were treated with NACT and ACT, respectively. Five-year OS was 25% [95% confidence interval (CI) 17% to 34%] for NACT, 29% (95% CI 25% to 33%) for ACT cases. Among patients with identifiable drug regimens, cisplatin was used in 82% (253/308) and carboplatin in 14% (43/308). The most common regimens were gemcitabine-cisplatin (54%, 166/308) and methotrexate, vinblastine, doxorubicin, cisplatin (MVAC) (21%, 66/308). Mean TTAC was 10 weeks; 23% of patients had TTAC >12 weeks. TTAC > 12 weeks was associated with inferior OS [hazard ratio (HR) 1.28, 95% CI 1.00-1.62] and CSS (HR 1.30, 95% CI 1.00-1.69). In adjusted analyses, OS and CSS were lower among patients treated with carboplatin compared with those treated with cisplatin; OS HR 2.14 (95% CI 1.40-3.29) and CSS HR 2.06 (95% CI 1.26-3.37).Conclusions: Most patients in the general population receive cisplatin, and this may be associated with superior outcomes to carboplatin. Initiation of ACT beyond 12 weeks is associated with inferior survival. Patients should start ACT as soon as they are medically fit to do so.