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Curative therapy for bladder cancer in routine clinical practice: A population-based outcomes study

机译:常规临床实践中膀胱癌的治疗方法:基于人群的结局研究

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Aims: Definitive therapy of bladder cancer involves cystectomy or radiotherapy; controversy exists regarding optimal management. Here we describe the management and outcomes of patients treated in routine practice. Materials and methods: Treatment records were linked to the Ontario Cancer Registry to identify all cases of bladder cancer in Ontario treated with cystectomy or radiotherapy in 1994-2008. Practice patterns are described in three study periods: 1994-1998, 1999-2003, 2004-2008. Logistic regression, Cox model and propensity score analyses were used to evaluate factors associated with treatment choice and survival. Results: In total, 3879 cases (74%) underwent cystectomy and 1380 (26%) were treated with primary radiotherapy. Cystectomy use increased over time (66, 75, 78%), whereas radiotherapy decreased (34, 25, 22%), P<0.001. There was substantial regional variation in the proportion of cases undergoing radiotherapy (range 16-51%). Five year cancer-specific survival (CSS) and overall survival were 40 and 36% for surgical cases and 35 and 26% for radiotherapy cases (P<0.001). In multivariate Cox model and propensity score analyses, there was no significant difference in CSS between surgery and radiotherapy (hazard ratio 0.99, 95% confidence interval 0.91-1.08); radiotherapy was associated with slightly inferior overall survival (hazard ratio 1.08, 95% confidence interval 1.00-1.16). Conclusion: Utilisation of cystectomy for bladder cancer in routine practice has increased over time with no evidence of a significant difference in CSS between radiotherapy and cystectomy.
机译:目的:膀胱癌的明确治疗包括膀胱切除术或放射治疗。关于最佳管理存在争议。在这里,我们描述了常规治疗中患者的管理和结果。材料和方法:将治疗记录与安大略省癌症登记处联系起来,以识别1994-2008年安大略省接受膀胱切除术或放射疗法治疗的所有膀胱癌病例。在三个研究阶段中描述了实践模式:1994-1998、1999-2003、2004-2008。 Logistic回归,Cox模型和倾向评分分析用于评估与治疗选择和生存相关的因素。结果:共有3879例(74%)接受了膀胱切除术,其中1380例(26%)接受了原发放疗。膀胱切除术的使用随时间增加(66%,75%,78%),而放疗减少(34%,25%,22%),P <0.001。接受放射治疗的病例比例存在很大的区域差异(范围为16-51%)。手术病例的五年癌症特异性生存率(CSS)和总生存率分别为40%和36%,放射治疗病例为35%和26%(P <0.001)。在多元Cox模型和倾向评分分析中,手术和放疗之间CSS的差异无统计学意义(危险比0.99,95%置信区间0.91-1.08)。放疗与总体生存稍差有关(危险比1.08,95%置信区间1.00-1.16)。结论:膀胱切除术在膀胱癌的常规实践中随着时间的推移而增加,没有证据表明放疗和膀胱切除术之间CSS的显着差异。

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