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Is neoadjuvant chemotherapy for pT2 bladder cancer associated with a survival benefit in a population-based analysis?
- Source :
- Cancer Epidemiology. 58:83-88
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Background: Patients with organ confined muscle-invasive bladder cancer (MIBC) who are candidates for radical cystectomy (RC) should receive neoadjuvant chemotherapy (CHT). However, the most contemporary CHT use rates indicate low adherence to these guidelines. We tested contemporary neoadjuvant CHT rates and associated cancer-specific mortality (CSM) and overall mortality (OM) in pT2N0 MIBC patients treated with RC. Materials and methods: Within the SEER database (2004–2015), we identified patients with pT2N0 MIBC patients who underwent RC. CHT administration rates were evaluated using estimated annual percentage changes (EAPCs) analyses. After inverse probability of treatment weighting (IPTW), Kaplan–Meier (KM) analyses and Cox regression models (CRMs) were used to test the effect of CHT vs no CHT on survival. Landmark analyses tested for immortal time bias. Results: Of 3978 RC patients, 38.2% of patients received CHT. Between 2004 and 2015, CHT rates increased from 15.9% to 66.2% (EAPC: +14.2%; p < 0.001). IPTW-adjusted KM showed 10-year CSM-free survival rates of 78.9% for CHT vs 76.7% for no CHT patients (p = 0.6). Similarly, IPTW-adjusted KM showed 10-year OM-free survival rates of 54.6% for CHT vs 57.9% for no CHT patients (p = 0.8). In IPTW-adjusted MCRMs, CHT was not significantly associated with lower CSM (HR 0.97, CI 0.82–1.14; p = 0.7) or OM (HR 1.02, CI 0.90–1.16; p = 0.7). Virtually the same CSM and OM rates were recorded after landmark analyses. Conclusions: CHT use in pT2N0 MIBC RC patients sharply increased over the study span. However, neoadjuvant CHT was not associated with better survival in this patient group.
- Subjects :
- Male
Oncology
Cancer Research
medicine.medical_specialty
Epidemiology
medicine.medical_treatment
Population based
Cystectomy
Inverse probability of treatment weighting
03 medical and health sciences
0302 clinical medicine
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
SEER program
medicine
Chemotherapy
Humans
030212 general & internal medicine
Patient group
Aged
Bladder cancer
Proportional hazards model
business.industry
Cancer-specific mortality
Middle Aged
Prognosis
medicine.disease
Neoadjuvant Therapy
United States
Survival Rate
Radical cystectomy
Survival benefit
Urinary Bladder Neoplasms
030220 oncology & carcinogenesis
Female
business
SEER Program
Subjects
Details
- ISSN :
- 18777821
- Volume :
- 58
- Database :
- OpenAIRE
- Journal :
- Cancer Epidemiology
- Accession number :
- edsair.doi.dedup.....73b2e325ba7163c9024ce6c6741fc139