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Increasing Rates of Perioperative Chemotherapy are Associated With Improved Survival in Men With Urothelial Bladder Cancer With Prostatic Stromal Invasion.
- Source :
-
Clinical genitourinary cancer [Clin Genitourin Cancer] 2020 Feb; Vol. 18 (1), pp. 35-44.e1. Date of Electronic Publication: 2019 Oct 17. - Publication Year :
- 2020
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Abstract
- Background: Our objective was to test whether the rates of perioperative chemotherapy (CHT) administration in patients with urothelial bladder cancer (UCUB) with prostatic stromal invasion (pT4a) changed over time. Moreover, we tested the effect of CHT on overall mortality (OM), as well as on cancer-specific mortality (CSM) in this patient population.<br />Materials and Methods: Within the Surveillance, Epidemiology, and End Results database (2004-2016), we identified 1513 men with non-metastatic UCUB with prostatic stromal invasion who underwent radical cystectomy with lymph node dissection, with or without CHT administration. Estimated annual percentage change analyses, inverse probability of treatment-weighting (IPTW), Kaplan-Meier plots, Cox regression models, and landmark analyses were performed.<br />Results: Overall, 732 (48.4%) patients with pT4a UCUB disease underwent radical cystectomy with perioperative CHT administration between 2004 and 2016. The CHT administration rate increased from 29.0% in 2004 to 64.8% in 2016 (P < .001). In IPTW-adjusted analyses, the 5-year overall survival was 47.7% versus 39.8%, and cancer-specific survival was 53.6 versus 50.1%, for with versus without CHT administration, respectively. After multivariable and IPTW-adjusted Cox regression models, administration of CHT independently predicted lower OM (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.52-0.73), as well as lower CSM (HR, 0.66; 95% CI, 0.55-0.80). even after 3-month landmark analyses (OM HR, 0.64; 95% CI 0.54-0.76; CSM HR, 0.70; 95% CI, 0.58-0.85).<br />Conclusions: The use of CHT in patients with pT4a UCUB increased from low to moderate in the most contemporary era. However, based on its impressive reduction in OM, as well as in CSM, further increases in CHT administration rates should be highly encouraged in this patient population.<br /> (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Carcinoma, Transitional Cell mortality
Carcinoma, Transitional Cell pathology
Chemotherapy, Adjuvant statistics & numerical data
Chemotherapy, Adjuvant trends
Cystectomy
Female
Humans
Kaplan-Meier Estimate
Lymph Node Excision
Male
Middle Aged
Neoadjuvant Therapy trends
Neoplasm Invasiveness pathology
Neoplasm Staging
Retrospective Studies
SEER Program statistics & numerical data
Treatment Outcome
United States epidemiology
Urinary Bladder pathology
Urinary Bladder surgery
Urinary Bladder Neoplasms mortality
Urinary Bladder Neoplasms pathology
Young Adult
Antineoplastic Agents therapeutic use
Carcinoma, Transitional Cell therapy
Neoadjuvant Therapy statistics & numerical data
Prostate pathology
Urinary Bladder Neoplasms therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1938-0682
- Volume :
- 18
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Clinical genitourinary cancer
- Publication Type :
- Academic Journal
- Accession number :
- 31711842
- Full Text :
- https://doi.org/10.1016/j.clgc.2019.10.012