当前位置: X-MOL 学术Bladder Cancer › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Benefit of Adjuvant Chemotherapy After Radical Cystectomy for Treatment of Urothelial Carcinoma of the Bladder in the Elderly –An International Multicenter Study
Bladder Cancer ( IF 1.1 ) Pub Date : 2021-01-26 , DOI: 10.3233/blc-200391
Victor M. Schuettfort 1, 2 , Benjamin Pradere 1, 3 , Hadi Mostafaei 1, 4 , Ekaterina Laukhtina 1, 5 , Keiichiro Mori 1, 6 , Fahad Quhal 1, 7 , Reza Sari Motlagh 1 , Michael Rink 2 , Pierre I. Karakiewicz 8 , Marina Deuker 8, 9 , Marco Moschini 10, 11, 12 , Lara Franziska Stolzenbach 8, 13 , Quoc-Dien Trinh 14 , Alberto Briganti 15 , David D’Andrea 1 , Shahrokh F. Shariat 1, 5, 16, 17, 18
Affiliation  

Abstract

BACKGROUND:

Radical cystectomy (RC) is the standard treatment for muscle invasive bladder cancer, but approximately half of all patients will ultimately succumb to disease progression despite apparent cure with extirpative surgery. Elderly patients are at especially high risk of advanced disease and may benefit from perioperative systemic therapy.

OBJECTIVE:

To assess the real-world benefit of adjuvant chemotherapy (AC) in patients ≥75 years old.

METHODS:

We retrospectively reviewed patients who underwent RC for non-metastatic urothelial carcinoma of the bladder (UCB) from 12 participating international medical institutions. Kaplan-Meier survival curves and Cox regression models were used to assess the association between age groups, administration of AC and oncological outcome parameters such as recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS).

RESULTS:

4,335 patients were included in the analyses, of which 820 (18.9%) were ≥75 years old. These elderly patients had a higher rate of adverse pathologic features. In an univariable subgroup analysis in patients ≥75 years with lymph node metastasis, 5-year OS was significantly higher in patients who had received AC (41% vs. 30.9%, p = 0.02). In a multivariable Cox model that was adjusted for several established outcome predictors, there was a significant favorable association between the administration of AC in elderly patients and OS, but no RFS or CSS.

CONCLUSIONS:

In this large observational study, the administration of AC was associated with improved OS, but not RFS or CSS, in elderly patients treated with RC for UCB. This is of clinical importance, as elderly patients are more likely to have adverse pathologic features and experience worse survival outcomes. Treatment of UCB should include both a multidisciplinary approach and a geriatric evaluation to identify patients who are most likely to tolerate and benefit from AC.



中文翻译:

膀胱膀胱癌根治术后辅助化疗对老年人膀胱尿路上皮癌的治疗作用-国际多中心研究

摘要

背景:

根治性膀胱切除术(RC)是肌肉浸润性膀胱癌的标准治疗方法,尽管经过彻底的根治性手术治愈,但仍有大约一半的患者最终会屈服于疾病进展。老年患者罹患晚期疾病的风险特别高,可能会从围手术期全身治疗中受益。

目的:

评估≥75岁患者的辅助化疗(AC)的实际获益。

方法:

我们回顾性分析了来自12个参与国际医疗机构的因非转移性膀胱尿路上皮癌(UCB)而接受RC的患者。使用Kaplan-Meier生存曲线和Cox回归模型评估年龄组,AC和肿瘤学结果参数(例如无复发生存期(RFS),癌症特异性生存期(CSS)和总体生存期(OS))之间的关联。

结果:

分析包括4,335例患者,其中≥75岁的有820例(18.9%)。这些老年患者具有较高的不良病理特征发生率。在≥75岁的淋巴结转移患者中进行单变量亚组分析,接受AC的患者5年OS显着更高(41%比30.9%,p = 0.02)。在针对多个既定结果预测指标进行了调整的多变量Cox模型中,老年患者AC的施用与OS之间存在显着的有利关联,但没有RFS或CSS。

结论:

在这项大型观察性研究中,对于接受UCB RC治疗的老年患者,AC的使用与OS改善相关,但与RFS或CSS没有改善。这具有临床重要性,因为老年患者更可能具有不良的病理特征并经历较差的生存结果。UCB的治疗应包括多学科方法和老年医学评估,以识别最有可能耐受AC并从AC中受益的患者。

更新日期:2021-01-29
down
wechat
bug