Comparison of Neoadjuvant and Adjuvant Chemotherapy in Muscle-invasive Bladder Cancer

医学 危险系数 四分位间距 膀胱癌 置信区间 内科学 新辅助治疗 肿瘤科 膀胱切除术 比例危险模型 围手术期 化疗 随机对照试验 癌症 外科 泌尿科 乳腺癌
作者
Liam C. Macleod,Mina Fam,Jonathan G. Yabes,Nathan Hale,Robert M. Turner,Samia Lopa,Jeffrey R. Gingrich,Tudor Borza,Ted A. Skolarus,Benjamin J. Davies,Bruce L. Jacobs
出处
期刊:Clinical Genitourinary Cancer [Elsevier BV]
卷期号:18 (3): 201-209.e2 被引量:14
标识
DOI:10.1016/j.clgc.2019.12.011
摘要

Background We use observational methods to compare impact of perioperative chemotherapy timing (ie, neoadjuvant and adjuvant) on overall survival (OS) in muscle-invasive bladder cancer because there is no head-to-head randomized trial, and patient factors may influence decision-making. Patients and Methods Using Surveillance, Epidemiology, and End Results-Medicare data, we identified patients receiving cystectomy for muscle-invasive bladder cancer diagnosed between 2004 and 2013. Patients were classified as receiving neoadjuvant or adjuvant chemotherapy. Propensity of receiving neoadjuvant chemotherapy was determined using gradient boosted models. Inverse probability of treatment weighted survival curves were adjusted for 13 demographic, socioeconomic, temporal, and oncologic covariates. Results We identified 1342 patients who received neoadjuvant (n = 676) or adjuvant chemotherapy (n = 666) with a median follow-up of 23 months (interquartile range, 9-55 months). Inverse probability of treatment weighted adjustment allows comparison of the groups head-to-head as well as counterfactual scenarios (eg, effect if those getting one treatment were to receive the other). The average treatment effect (ie, "head-to-head" comparison) of adjuvant compared with neoadjuvant on OS was not significant (hazard ratio, 1.14; 95% confidence interval, 0.99-1.31). However, the average treatment effect of the treated (ie, the effect if the neoadjuvant patients were to receive adjuvant instead) was associated with a 33% increase in risk of mortality if they were given adjuvant therapy instead (hazard ratio, 1.33; 95% confidence interval, 1.12-1.57). Conclusion Significant treatment selection bias was noted in peri-cystectomy timing, which limits the ability to discriminate differential efficacy of these 2 approaches with observational data. However, patients with higher propensity to receive neoadjuvant therapy were predicted to have increased OS with approach, in keeping with existing paradigms from trial data.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
自由的聋五完成签到,获得积分20
1秒前
1秒前
1秒前
Lucas应助苏黎世采纳,获得10
2秒前
科研通AI2S应助Licy采纳,获得10
2秒前
简单以冬发布了新的文献求助10
2秒前
3秒前
Leohp发布了新的文献求助10
3秒前
荀中道发布了新的文献求助10
3秒前
哈哈哈大赞完成签到,获得积分10
3秒前
澤少完成签到,获得积分10
3秒前
chen666完成签到,获得积分10
3秒前
4秒前
王锋完成签到,获得积分10
4秒前
晨Zhi完成签到,获得积分10
5秒前
6秒前
6秒前
cangye完成签到,获得积分10
7秒前
快乐的晟睿完成签到,获得积分10
7秒前
不要科研发布了新的文献求助10
7秒前
YU发布了新的文献求助10
7秒前
8秒前
9秒前
Yorshka完成签到,获得积分10
9秒前
10秒前
cxzdm发布了新的文献求助20
11秒前
11秒前
12秒前
LC发布了新的文献求助10
12秒前
Maroon5发布了新的文献求助10
12秒前
13秒前
hyper3than发布了新的文献求助10
14秒前
15秒前
勤奋的诗珊完成签到,获得积分10
16秒前
务实蜻蜓发布了新的文献求助10
16秒前
16秒前
广州队完成签到,获得积分10
16秒前
菲菲发布了新的文献求助10
17秒前
17秒前
情怀应助俊逸的银耳汤采纳,获得10
17秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
Cognitive Neuroscience: The Biology of the Mind 1000
Technical Brochure TB 814: LPIT applications in HV gas insulated switchgear 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
Picture Books with Same-sex Parented Families: Unintentional Censorship 500
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3970172
求助须知:如何正确求助?哪些是违规求助? 3514982
关于积分的说明 11176568
捐赠科研通 3250212
什么是DOI,文献DOI怎么找? 1795198
邀请新用户注册赠送积分活动 875702
科研通“疑难数据库(出版商)”最低求助积分说明 805004