Objectives: To test the effect of systemic chemotherapy on cancer-specific mortality (CSM) in patients with adenocarcinoma of the urinary bladder (ADKUB). Materials and methods: 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. Results: 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). Conclusions: 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.
The Effect of Systemic Chemotherapy on Survival in Patients With Localized, Regional, or Metastatic Adenocarcinoma of the Urinary Bladder / S. Luzzago, C. Palumbo, G. Rosiello, A. Pecoraro, M. Deuker, F.A. Mistretta, Z. Tian, G. Musi, E. Montanari, S.F. Shariat, F. Saad, A. Briganti, O. de Cobelli, P.I. Karakiewicz. - In: AMERICAN JOURNAL OF CLINICAL ONCOLOGY: CANCER CLINICAL TRIALS. - ISSN 0277-3732. - 43:8(2020 Aug), pp. 567-574.
|Titolo:||The Effect of Systemic Chemotherapy on Survival in Patients With Localized, Regional, or Metastatic Adenocarcinoma of the Urinary Bladder|
LUZZAGO, STEFANO (Corresponding)
|Parole Chiave:||adenocarcinoma; chemotherapy; propensity score; inverse probability of treatment weighting adjustement; bladder cancer|
|Settore Scientifico Disciplinare:||Settore MED/24 - Urologia|
|Data di pubblicazione:||ago-2020|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1097/COC.0000000000000704|
|Appare nelle tipologie:||01 - Articolo su periodico|
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