Differential Analysis of Surgical Treatment Modalities in T2N0M0 Bladder Cancer Patients: A Novel Propensity Score-Based Cohort Study

IF 2.3 3区医学 Q3 ONCOLOGY

Clinical genitourinary cancer Pub Date : 2024-11-02 DOI:10.1016/j.clgc.2024.102257

Yu-Xuan Yang, Gui-Chen Ye, Jia-Cheng Xiang, Kuang-Di Luo, Shao-Gang Wang , Qi-Dong Xia

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引用次数: 0

Abstract

Objective

This study explored prognostic differences between radical cystectomy (RC), tri-modality treatment (TURBt combined with radiotherapy and chemotherapy, TMT), electrocautery (EC) and partial cystectomy (PC) for T2N0M0 MIBC.

Materials and Methods

Using SEER data (2004-2015, 2018-2020), we identified T2N0M0 MIBC patients treated with RC, TMT, EC, or PC. Propensity score matching (PSM, 1:1, caliper=0.1) minimized confounding. Kaplan-Meier analysis and Cox regression identified independent prognostic factors, stratified by tumor size and age.

Result

This study included 6526 patients with T2N0M0 MIBC. Among them, 348(5.33%) underwent PC, 309(4.73%)underwent EC, 1833(28.09%)received TMT, and 4036(61.84%) RC. After 1:1 propensity score matching, RC showed improved CSS (HR=0.67, 95%CI 0.47-0.95 , and PC also benefited (HR=0.97, 95%CI 0.69-1.36) compared to EC. While TMT showed a worse end (HR=1.41, 95%Cl 1.03-1.92) compared to EC. Cox analysis was used to stratify tumor size and age for subgroup analysis. Results for tumor size subgroups were aligned with PSM findings. In the age-stratified subgroups, patients aged <67 years, both RC (HR=0.54, P=0.107) and TMT(HR=0.91, P=0.785) showed better prognoses compared to EC treatment, while PC treatment showed worse prognoses compared to EC treatment (HR=1.23, P=0.542).; for 68-77 years, RC(0.64, P=0.1436) and PC(HR=0.46, P=0.0283)had advantages, and PC is more recommended. For >78 years, RC had superior CSS over EC and PC, whereas TMT had the poorest prognosis.

Conclusion

In clinical T2N0M0 MIBC, overall, RC outperformed focal-tumor therapy and PC, irrespective of tumor size. However, considering age, we recommend PC treatment for patients aged 68-77 and EC for those aged >78 years.

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T2N0M0膀胱癌患者手术治疗方式的差异分析：基于倾向评分的新型队列研究

研究目的本研究探讨了根治性膀胱切除术（RC）、三联疗法（TURBt联合放疗和化疗，TMT）、电灼术（EC）和膀胱部分切除术（PC）治疗T2N0M0 MIBC的预后差异：利用 SEER 数据（2004-2015 年，2018-2020 年），我们确定了接受 RC、TMT、EC 或 PC 治疗的 T2N0M0 MIBC 患者。倾向评分匹配（PSM，1:1，卡方=0.1）将混杂因素降至最低。Kaplan-Meier分析和Cox回归确定了独立的预后因素，并根据肿瘤大小和年龄进行了分层：本研究共纳入 6526 例 T2N0M0 MIBC 患者。其中，348人（5.33%）接受了PC治疗，309人（4.73%）接受了EC治疗，1833人（28.09%）接受了TMT治疗，4036人（61.84%）接受了RC治疗。经过1:1倾向得分匹配后，与EC相比，RC显示CSS有所改善（HR=0.67，95%CI 0.47-0.95），PC也有所改善（HR=0.97，95%CI 0.69-1.36）。与 EC 相比，TMT 的结局较差（HR=1.41，95%CI 1.03-1.92）。Cox分析法对肿瘤大小和年龄进行分层，以进行亚组分析。肿瘤大小亚组的结果与 PSM 结果一致。在年龄分层亚组中，78岁的患者中，RC的CSS优于EC和PC，而TMT的预后最差：在临床T2N0M0 MIBC中，无论肿瘤大小，RC的总体疗效优于病灶肿瘤治疗和PC。不过，考虑到年龄因素，我们建议 68-77 岁的患者接受 PC 治疗，而年龄大于 78 岁的患者接受 EC 治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical genitourinary cancer 医学-泌尿学与肾脏学

CiteScore

5.20

自引率

6.20%

发文量

201

审稿时长

54 days

期刊介绍： Clinical Genitourinary Cancer is a peer-reviewed journal that publishes original articles describing various aspects of clinical and translational research in genitourinary cancers. Clinical Genitourinary Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of genitourinary cancers. The main emphasis is on recent scientific developments in all areas related to genitourinary malignancies. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.