Dose dense MVAC prior to radical cystectomy: a real-world experience
Dose dense MVAC prior to radical cystectomy: a real-world experience
复制标题
根治性膀胱切除术前给予密集 MVAC：真实经验
DOI：
10.1007/s00345-017-2065-x
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发表时间：
2017
影响因子：
3.4
通讯作者：
W. Kassouf
中科院分区：
文献类型：
--
作者：
H. Zargar;J. Shah;E. E. F. van de Putte;K. Potvin;K. Zargar;B. V. van Rhijn;S. Daneshmand;J. Holzbeierlein;P. Spiess;E. Winquist;S. Horenblas;C. Dinney;P. Black;W. Kassouf
目的
在这个真实世界的多机构队列中，我们的主要终点是评估膀胱癌（BCa）患者在接受加速或剂量密集的甲氨蝶呤 - 长春碱 - 多柔比星 - 顺铂（ddMVAC）化疗后行根治性膀胱切除术（RC）的病理缓解率（pT0N0和≤pT1N0）。
材料与方法
我们回顾性分析了2000年至2015年在7个协作机构接受ddMVAC和RC的尿路上皮癌患者的病历。纳入cT2 - 4a、M0的膀胱癌患者。初始经尿道膀胱肿瘤切除标本中存在cT3 - 4疾病、肾积水、淋巴管浸润和/或存在肉瘤样或微乳头特征被定义为高危疾病。针对整个队列以及cN0亚组建立了预测pT0N0和≤pT1N0的逻辑回归模型。使用根治性膀胱切除术后数据建立多变量Cox比例风险回归生存模型，以评估感兴趣变量的风险比（HRs）。
结果
在研究期间，共有345名患者接受了ddMVAC化疗；85%具有高危特征。化疗周期的中位数为4个（四分位距4 - 4）；>90%的患者完成了所有预定周期。在cN0患者中，pT0N0和≤pT1N0的观察率分别为30.4%和49.3%。在多变量回归模型中，存在一种以上临床高危因素与实现部分病理缓解的几率降低70%相关[比值比0.30，95%置信区间（0.10 - 0.86）；p = 0.02]。
结论
在新辅助ddMVAC治疗后，三分之一的患者观察到完全缓解（pT0N0），在这种方案的真实世界应用中，近一半的病例观察到部分缓解（≤pT1N0）。据我们所知，这是临床试验环境之外最大规模的经验。
PurposeOur primary endpoint was to assess pathological response rate (pT0N0 and ≤pT1N0) for patients with BCa treated with the accelerated or dose dense MVAC (ddMVAC) chemotherapy followed by radical cystectomy (RC) in this real-word multi-institutional cohort.Materials and methodsWe retrospectively reviewed records of patients with urothelial cancer who underwent ddMVAC and RC at seven contributing institutions from 2000 to 2015. Patients with cT2–4a, M0 BCa were included. Presence of cT3–4 disease, hydronephrosis, lymphovascular invasion and/or existence of sarcomatoid, or micropapillary features on the initial transurethral resection of bladder tumor specimen was defined as high-risk disease. Logistic regression models for prediction of pT0N0 and ≤pT1N0 were generated for the entire cohort as well as for the cN0 subgroup. The multivariable Cox proportional hazards regression model for survival using post RC data was used to assess hazard ratios (HRs) for the variables of interest.ResultsA total of 345 patients received ddMVAC chemotherapy during the study period; 85% had high-risk features. The median number of chemotherapy cycles was 4 (IQR 4-4); >90% of patients completed all scheduled cycles. The observed rates of pT0N0 and ≤pT1N0 were 30.4 and 49.3%, respectively, among cN0 patients. On the multivariable regression model, the presence of more than one clinical high-risk element was associated with 70% [OR 0.30 95% CI (0.10–0.86); p = 0.02] reduction in the odds of achieving partial pathological response.ConclusionsA complete response (pT0N0) was observed in one-third of patients after neoadjuvant ddMVAC therapy, and a partial response (≤pT1N0) was observed in nearly half of the cases in this real-world experience with this regimen. To our knowledge, this represents the largest experience outside clinical trial settings.
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影响因子：
6.6
作者：
Culp, Stephen H.;Dickstein, Rian J.;Grossman, H. Barton;Pretzsch, Shanna M.;Porten, Sima;Daneshmand, Siamak;Cai, Jie;Groshen, Susan;Siefker-Radtke, Arlene;Millikan, Randall E.;Czerniak, Bogdan;Navai, Neema;Wszolek, Matthew F.;Kamat, Ashish M.;Dinney, Colin P. N.
通讯作者：
Dinney, Colin P. N.
影响因子：
158.5
作者：
Grossman, HB;Natale, RB;Crawford, ED
通讯作者：
Crawford, ED
影响因子：
28.2
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Van Allen EM;Mouw KW;Kim P;Iyer G;Wagle N;Al-Ahmadie H;Zhu C;Ostrovnaya I;Kryukov GV;O'Connor KW;Sfakianos J;Garcia-Grossman I;Kim J;Guancial EA;Bambury R;Bahl S;Gupta N;Farlow D;Qu A;Signoretti S;Barletta JA;Reuter V;Boehm J;Lawrence M;Getz G;Kantoff P;Bochner BH;Choueiri TK;Bajorin DF;Solit DB;Gabriel S;D'Andrea A;Garraway LA;Rosenberg JE
通讯作者：
Rosenberg JE
影响因子：
45.3
作者：
Griffiths, Gareth
通讯作者：
Griffiths, Gareth
影响因子：
23.4
作者：
Plimack ER;Dunbrack RL;Brennan TA;Andrake MD;Zhou Y;Serebriiskii IG;Slifker M;Alpaugh K;Dulaimi E;Palma N;Hoffman-Censits J;Bilusic M;Wong YN;Kutikov A;Viterbo R;Greenberg RE;Chen DY;Lallas CD;Trabulsi EJ;Yelensky R;McConkey DJ;Miller VA;Golemis EA;Ross EA
通讯作者：
Ross EA