PDF(Pubmed)
Abstract：
UNASSIGNED: Cisplatin-based combination chemotherapy alone is currently considered the standard of care for patients with metastatic upper tract urothelial carcinoma (mUTUC). However, less research has been done on the efficacy of other combinations. In this study, we explored the role of cytoreductive surgery in patients with mUTUC receiving different types of systemic therapy.
UNASSIGNED: Data from 9,436 anonymized records were abstracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2008-2018. Of these, 508 individuals received systemic therapy subsequent to being diagnosed with mUTUC. These patients had all been treated with systemic therapies such as chemotherapy and/or radiotherapy. Patients were stratified into either a non-surgical or surgical group based on cytoreductive surgery status before systemic therapeutics commenced. Kaplan-Meier curves were used to compare overall survival (OS) and cancer-specific survival (CSS). Cox\'s proportional hazard models were then used to analyze prognostic factors related to OS and CSS.
UNASSIGNED: Of the 508 cases, 36.8% (n=187) had received cytoreductive surgery with systemic treatments. The remaining 63.2% (n=321) received either chemotherapy and/or radiotherapy alone. Kaplan-Meier curves showed that 11.6% had 3-year OS [95% confidential interval (CI): 7.1-17.3] for cytoreductive surgery with systemic treatment and 4.9% (95% CI: 2.7-8.0) for systemic treatment alone (P=0.001). The 3-year CSS was 14.9% for cytoreductive surgery plus systemic treatment (95% CI: 9.4-21.7%) and 6.0% (95% CI: 3.4-9.8%) for systemic treatments alone (P=0.003). Under multivariate regression analysis, primary ureter site OS had a hazard ratio (HR) of 0.74 (95% CI: 0.58-0.95, P=0.02) and a CSS HR of 0.72 (95% CI: 0.56-0.94, P=0.01). The cytoreductive surgery OS HR was 0.79 (95% CI: 0.65-0.95, P=0.02) and the CSS HR was 0.75 (95% CI: 0.61-0.92, P=0.006). Additionally, chemotherapy had an OS HR of 0.46 (95% CI: 0.33-0.0.65, P<0.001) and a CSS HR of 0.44 (95% CI: 0.31-0.63, P<0.001). Bones and liver metastases were also indicative of poorer prognosis. Validation was conducted through subgroup analysis which suggested cytoreductive surgery was effective only for patients who received chemotherapy or combined chemo-radiotherapy but not for radiotherapy alone.
UNASSIGNED: Cytoreductive surgery provided significantly increased OS and CSS for mUTUC patients who received chemotherapy or combined chemo-radiotherapy in this study. In addition, the primary tumor and metastatic sites were shown to be related to improved patient survival although this was a small and relatively homogeneous cohort of study, sample therefore, further research is required.
UNASSIGNED: Data from 9,436 anonymized records were abstracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2008-2018. Of these, 508 individuals received systemic therapy subsequent to being diagnosed with mUTUC. These patients had all been treated with systemic therapies such as chemotherapy and/or radiotherapy. Patients were stratified into either a non-surgical or surgical group based on cytoreductive surgery status before systemic therapeutics commenced. Kaplan-Meier curves were used to compare overall survival (OS) and cancer-specific survival (CSS). Cox\'s proportional hazard models were then used to analyze prognostic factors related to OS and CSS.
UNASSIGNED: Of the 508 cases, 36.8% (n=187) had received cytoreductive surgery with systemic treatments. The remaining 63.2% (n=321) received either chemotherapy and/or radiotherapy alone. Kaplan-Meier curves showed that 11.6% had 3-year OS [95% confidential interval (CI): 7.1-17.3] for cytoreductive surgery with systemic treatment and 4.9% (95% CI: 2.7-8.0) for systemic treatment alone (P=0.001). The 3-year CSS was 14.9% for cytoreductive surgery plus systemic treatment (95% CI: 9.4-21.7%) and 6.0% (95% CI: 3.4-9.8%) for systemic treatments alone (P=0.003). Under multivariate regression analysis, primary ureter site OS had a hazard ratio (HR) of 0.74 (95% CI: 0.58-0.95, P=0.02) and a CSS HR of 0.72 (95% CI: 0.56-0.94, P=0.01). The cytoreductive surgery OS HR was 0.79 (95% CI: 0.65-0.95, P=0.02) and the CSS HR was 0.75 (95% CI: 0.61-0.92, P=0.006). Additionally, chemotherapy had an OS HR of 0.46 (95% CI: 0.33-0.0.65, P<0.001) and a CSS HR of 0.44 (95% CI: 0.31-0.63, P<0.001). Bones and liver metastases were also indicative of poorer prognosis. Validation was conducted through subgroup analysis which suggested cytoreductive surgery was effective only for patients who received chemotherapy or combined chemo-radiotherapy but not for radiotherapy alone.
UNASSIGNED: Cytoreductive surgery provided significantly increased OS and CSS for mUTUC patients who received chemotherapy or combined chemo-radiotherapy in this study. In addition, the primary tumor and metastatic sites were shown to be related to improved patient survival although this was a small and relatively homogeneous cohort of study, sample therefore, further research is required.
摘要：
■目前认为以顺铂为基础的联合化疗是转移性上尿路上皮癌（mUTUC）患者的标准治疗方法。然而,关于其他组合的疗效的研究较少。在这项研究中,我们探讨了细胞减灭术在接受不同类型全身治疗的mUTUC患者中的作用.
■从监视中提取了9,436条匿名记录的数据，流行病学,和2008-2018年的最终结果(SEER)数据库。其中,508名个体在诊断为mUTUC后接受了全身治疗。这些患者都接受了全身治疗，如化疗和/或放疗。在开始全身治疗之前，根据细胞减灭术状态将患者分为非手术组或手术组。使用Kaplan-Meier曲线比较总生存期(OS)和癌症特异性生存期(CSS)。然后使用Cox的比例风险模型分析与OS和CSS相关的预后因素。
■在508个案例中，36.8%(n=187)接受过细胞减灭术和全身治疗。其余63.2%(n=321)单独接受化疗和/或放疗。Kaplan-Meier曲线显示，对于全身治疗的细胞减灭术，11.6％的患者有3年的OS[95％的机密间隔（CI）：7.1-17.3]，而单独的全身治疗为4.9％（95％CI：2.7-8.0）（P=0.001）。细胞减灭术加全身治疗的3年CSS为14.9％（95％CI：9.4-21.7％），仅全身治疗为6.0％（95％CI：3.4-9.8％）（P=0.003）。在多元回归分析下，主要输尿管部位OS的风险比(HR)为0.74(95%CI:0.58-0.95,P=0.02),CSSHR为0.72(95%CI:0.56-0.94,P=0.01).细胞减灭术OSHR为0.79(95%CI:0.65-0.95,P=0.02),CSSHR为0.75(95%CI:0.61-0.92,P=0.006)。此外,化疗的OSHR为0.46(95%CI:0.33-0.0.65,P<0.001),CSSHR为0.44(95%CI:0.31-0.63,P<0.001).骨骼和肝转移也表明预后较差。通过亚组分析进行验证，表明细胞减灭术仅对接受化疗或联合化疗的患者有效，而对单独放疗无效。
■细胞减灭术为在本研究中接受化疗或联合化疗的mUTUC患者提供了显著增加的OS和CSS。此外,尽管这是一个小且相对均匀的研究队列，但发现原发肿瘤和转移部位与改善患者生存率相关。因此，样本，需要进一步的研究。
■从监视中提取了9,436条匿名记录的数据，流行病学,和2008-2018年的最终结果(SEER)数据库。其中,508名个体在诊断为mUTUC后接受了全身治疗。这些患者都接受了全身治疗，如化疗和/或放疗。在开始全身治疗之前，根据细胞减灭术状态将患者分为非手术组或手术组。使用Kaplan-Meier曲线比较总生存期(OS)和癌症特异性生存期(CSS)。然后使用Cox的比例风险模型分析与OS和CSS相关的预后因素。
■在508个案例中，36.8%(n=187)接受过细胞减灭术和全身治疗。其余63.2%(n=321)单独接受化疗和/或放疗。Kaplan-Meier曲线显示，对于全身治疗的细胞减灭术，11.6％的患者有3年的OS[95％的机密间隔（CI）：7.1-17.3]，而单独的全身治疗为4.9％（95％CI：2.7-8.0）（P=0.001）。细胞减灭术加全身治疗的3年CSS为14.9％（95％CI：9.4-21.7％），仅全身治疗为6.0％（95％CI：3.4-9.8％）（P=0.003）。在多元回归分析下，主要输尿管部位OS的风险比(HR)为0.74(95%CI:0.58-0.95,P=0.02),CSSHR为0.72(95%CI:0.56-0.94,P=0.01).细胞减灭术OSHR为0.79(95%CI:0.65-0.95,P=0.02),CSSHR为0.75(95%CI:0.61-0.92,P=0.006)。此外,化疗的OSHR为0.46(95%CI:0.33-0.0.65,P<0.001),CSSHR为0.44(95%CI:0.31-0.63,P<0.001).骨骼和肝转移也表明预后较差。通过亚组分析进行验证，表明细胞减灭术仅对接受化疗或联合化疗的患者有效，而对单独放疗无效。
■细胞减灭术为在本研究中接受化疗或联合化疗的mUTUC患者提供了显著增加的OS和CSS。此外,尽管这是一个小且相对均匀的研究队列，但发现原发肿瘤和转移部位与改善患者生存率相关。因此，样本，需要进一步的研究。
