Survival Outcomes and Temporal Trends of Non-Surgical Management Vs Radical Cystectomy in Non-Organ-Confined Urothelial Bladder Cancer

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology Pub Date : 2025-06-01 DOI:10.1016/j.urology.2025.02.051

Mattia Longoni , Natali Rodriguez Peñaranda , Andrea Marmiroli , Fabian Falkenbach , Quynh Chi Le , Michele Nicolazzini , Calogero Catanzaro , Zhe Tian , Jordan A. Goyal , Stefano Puliatti , Ottavio De Cobelli , Markus Graefen , Felix K.H. Chun , Carlotta Palumbo , Riccardo Schiavina , Fred Saad , Shahrokh F. Shariat , Marco Moschini , Giorgio Gandaglia , Francesco Montorsi , Pierre I. Karakiewicz

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引用次数: 0

Abstract

Objective

To investigate whether bimodal therapy (BMT) or trimodal therapy (TMT) differ from radical cystectomy (RC) + perioperative chemotherapy (CT) in cancer control outcomes among patients with non-organ-confined (NOC; T3-4 and/or N1-3) urothelial carcinoma of the urinary bladder (UCUB).

Methods

Within the Surveillance, Epidemiology, and End Results database (2005-2021), rates of BMT vs TMT vs RC + CT use in NOC UCUB patients were tabulated. Nearest-neighbor 1:1 propensity score matching (PSM) for age, sex, stage, and race/ethnicity was applied. Cumulative incidence plots depicted 5-year cancer-specific (CSM) and other-cause mortality (OCM) rates. Univariable and multivariable competing risks regression (CRR) models were fitted. Sensitivity analyses focused within T3-4,N0 patients.

Results

Of 7401 NOC UCUB patients, 1645 (22.2%) received BMT vs 884 (11.9%) TMT vs 4872 (65.8%) RC+CT. Over the study period, BMT and TMT rates have not significantly changed. After PSM, the five-year CSM rate was 66.2% after BMT vs 44.9% after RC + CT and BMT was associated with 2.1-fold higher CSM relative to RC + CT (multivariable HR [mHR]: 2.12, P <.001). After PSM, 5-year CSM rates was 61.1% after TMT vs 46.6% after RC and TMT was associated with 1.6-fold higher CSM relative to RC (mHR: 1.63, P <.001). Virtually the same findings were found within T3-4,N0 patients.

Conclusion

Approximately three out of ten NOC UCUB patients were treated with either BMT or TMT. However, such practice was invariably associated with higher CSM relative to RC + CT. These observations should be discussed at clinical decision-making and prior to informed consent.

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非器官限制性尿路上皮性膀胱癌非手术治疗与根治性膀胱切除术的生存结果和时间趋势。

目的：探讨双峰治疗（BMT）或三峰治疗（TMT）与根治性膀胱切除术(RC) +围手术期化疗（CT）在非器官限制性（NOC）患者的肿瘤控制结果是否存在差异；T3-4和/或N1-3)膀胱尿路上皮癌（UCUB）。方法：在SEER数据库（2005-2021）中，将NOC UCUB患者使用BMT、TMT和RC+CT的比率制成表格。采用年龄、性别、分期和种族/民族的最近邻1:1倾向评分匹配（PSM）。累积发病率图描述了5年癌症特异性（CSM）和其他原因死亡率（OCM）。拟合单变量和多变量竞争风险回归（CRR）模型。敏感性分析集中在T3-4，N0例患者中。结果：在7401例NOC UCUB患者中，1645例（22.2%）接受BMT治疗，884例（11.9%）接受TMT治疗，4872例（65.8%）接受RC+CT治疗。在研究期间，BMT和TMT率没有显著变化。PSM后，BMT后5年的CSM率为66.2%，而RC+CT后为44.9%，BMT相关的CSM比RC+CT高2.1倍(多变量HR [mHR]: 2.12， p结论：大约3 / 10的NOC UCUB患者接受BMT或TMT治疗。然而，相对于RC+CT，这种做法总是与更高的CSM相关。这些观察结果应在临床决策和知情同意之前进行讨论。

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

Urology 医学-泌尿学与肾脏学

CiteScore

3.30

自引率

9.50%

发文量

716

审稿时长

59 days

期刊介绍： Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.