The Effect of Systemic Chemotherapy on Survival in Patients With Localized, Regional, or Metastatic Adenocarcinoma of the Urinary Bladder.


Journal

American journal of clinical oncology
ISSN: 1537-453X
Titre abrégé: Am J Clin Oncol
Pays: United States
ID NLM: 8207754

Informations de publication

Date de publication:
08 2020
Historique:
pubmed: 30 5 2020
medline: 30 10 2020
entrez: 30 5 2020
Statut: ppublish

Résumé

To test the effect of systemic chemotherapy on cancer-specific mortality (CSM) in patients with adenocarcinoma of the urinary bladder (ADKUB). Within the Surveillance, Epidemiology, and End Results registry (2004 to 2016), we identified patients with localized (T2-3N0M0), regional (T4N0M0/TanyN1-3M0), and metastatic (TanyNanyM1) ADKUB. Temporal trends, Kaplan-Meier plots, and multivariable Cox regression models were used before and after 1:1 propensity score matching and inverse probability of treatment weighting. Of 1537 patients with ADKUB, 834 (54.0%), 363 (23.5%), and 340 (22.5%) harbored localized, regional, and metastatic disease, respectively. The rates of chemotherapy use increased in localized (estimated annual percentage change [EAPC]: +2.7%; P=0.03) and regional ADKUB (EAPC: +2.4%; P=0.04). Conversely, chemotherapy rates remained stable in metastatic patients (EAPC: +1.6%; P=0.4). In multivariable Cox regression models, chemotherapy use was associated with lower CSM in metastatic ADKUB (hazard ratio [HR]: 0.5; P=0.003), but not in either localized (HR: 0.8; P=0.2) or in regional ADKUB (HR: 1.0; P=0.9). In metastatic ADKUB, the benefit of chemotherapy on CSM persisted after 1:1 propensity score matching (HR: 0.6; P=0.002) and after inverse probability of treatment weighting (HR: 0.4; P<0.001). Chemotherapy improves survival in metastatic ADKUB. However, only one out of 2 such patients benefit from chemotherapy. In consequence, greater emphasis on chemotherapy use may be warranted in these patients. Conversely, no benefit was identified in localized or regional ADKUB.

Identifiants

pubmed: 32467527
doi: 10.1097/COC.0000000000000704
pii: 00000421-202008000-00006
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

567-574

Références

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Auteurs

Stefano Luzzago (S)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.
Department of Urology, European Institute of Oncology, IRCCS.

Carlotta Palumbo (C)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.
Department of Medical and Surgical Specialties, Radiological Science and Public Health, Urology Unit, ASST Spedali Civili of Brescia, University of Brescia, Brescia.

Giuseppe Rosiello (G)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.
Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute.

Angela Pecoraro (A)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.
Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy.

Marina Deuker (M)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.
Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.

Francesco A Mistretta (FA)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.
Department of Urology, European Institute of Oncology, IRCCS.

Zhe Tian (Z)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.

Gennaro Musi (G)

Department of Urology, European Institute of Oncology, IRCCS.

Emanuele Montanari (E)

Department of Urology, IRCCS Fondazione Ca' Granda-Ospedale Maggiore Policlinico.

Shahrokh F Shariat (SF)

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Department of Urology, Weill Cornell Medical College, New York, NY.
Department of Urology, University of Texas Southwestern, Dallas, TX.
Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republicm.
Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.

Fred Saad (F)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.

Alberto Briganti (A)

Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute.

Ottavio de Cobelli (O)

Department of Urology, European Institute of Oncology, IRCCS.
Department of Oncology and Hemato-Oncology, University of Milan, Milan.

Pierre I Karakiewicz (PI)

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.

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