Trends in neoadjuvant chemotherapy use and oncological outcomes for muscle-invasive bladder cancer in Japan: a multicenter study.
Trends in neoadjuvant chemotherapy use and oncological outcomes for muscle-invasive bladder cancer in Japan: a multicenter study.
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DOI：
10.18632/oncotarget.20991
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发表时间：
2017-10-17
期刊：
影响因子：
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通讯作者：
Ohyama C
中科院分区：
文献类型：
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作者：
Anan G;Hatakeyama S;Fujita N;Iwamura H;Tanaka T;Yamamoto H;Tobisawa Y;Yoneyama T;Yoneyama T;Hashimoto Y;Koie T;Ito H;Yoshikawa K;Kawaguchi T;Sato M;Ohyama C
尽管新辅助化疗（NAC）的益处，但肌肉浸润性膀胱癌（MIBC）患者使用NAC的指南建议的采用进展缓慢。我们的目的是评估MIBC患者代表性队列中NAC使用和肿瘤学结局的时间趋势。我们纳入了1996-2017年来自4家医院的532例因≥ cT 2 MIBC接受根治性膀胱切除术（RC）的患者。我们回顾性评估了NAC使用的时间变化以及无进展生存期和总生存期。NAC的候选者给予顺铂或卡铂为基础的方案。采用多变量考克斯回归分析和治疗加权逆概率（IPTW）模型研究NAC对肿瘤结局的影响。在532例患者中，336例接受NAC后再接受RC（NAC组），196例仅接受RC（对照组）。NAC的使用率从10%（1996-2004）显著增加到83%（2005-2016）。接受顺铂和卡铂方案治疗的患者数量分别为43例和280例。与对照组相比，NAC组的肿瘤学结局显著改善。IPTW模型的多变量分析显示，NAC显著改善了MIBC患者的肿瘤结局。5年总生存率的列线图预测接受NAC的患者改善16%。2005年后，MIBC对NAC的使用有所增加。用于MIBC的铂基NAC可能改善肿瘤学结局。
Despite benefits of neoadjuvant chemotherapy (NAC), the adoption of guideline recommendations for NAC use in patients with muscle-invasive bladder cancer (MIBC) has been slow. We aimed to evaluate temporal trends in NAC use and oncological outcomes in a representative cohort of patients with MIBC. We included 532 patients from 4 hospitals who underwent radical cystectomy (RC) for ≥ cT2 MIBC in 1996–2017. We retrospectively evaluated temporal changes in NAC use and progression-free and overall survival. Candidates for NAC were administered with either cisplatin- or carboplatin-based regimens. The impact of NAC on oncological outcomes was examined using multivariate Cox regression analysis with inverse probability of treatment weighting (IPTW) models. Of 532 patients, 336 underwent NAC followed by RC (NAC group) and 196 underwent RC alone (Ctrl group). NAC use significantly increased from 10% (1996–2004) to 83% (2005–2016). The number of patients administered with cisplatin- and carboplatin-based regimens was 43 and 280, respectively. Oncological outcomes in the NAC group were significantly improved compared to those in the Ctrl group. Multivariable analysis with IPTW models revealed that NAC significantly improved oncological outcomes in patients with MIBC. A nomogram for 5-year overall survival predicted 16% improvement in patients undergoing NAC. NAC use for MIBC increased after 2005. Platinum-based NAC for MIBC potentially improves oncological outcomes.