Cancer-Specific Mortality of Partial Cystectomy Versus Radical Cystectomy in T2N0M0 Urothelial Bladder Cancer.

IF 3.5 2区 医学 Q2 ONCOLOGY
Annals of Surgical Oncology Pub Date : 2025-08-01 Epub Date: 2025-05-27 DOI:10.1245/s10434-025-17488-2
Mattia Longoni, Andrea Marmiroli, Fabian Falkenbach, Quynh Chi Le, Michele Nicolazzini, Calogero Catanzaro, Federico Polverino, Zhe Tian, Jordan A Goyal, Matteo Ferro, Markus Graefen, Felix K H Chun, Alessandro Volpe, Riccardo Schiavina, Nicola Longo, Fred Saad, Shahrokh F Shariat, Marco Moschini, Giorgio Gandaglia, Francesco Montorsi, Alberto Briganti, Pierre I Karakiewicz
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引用次数: 0

Abstract

Background: The authors hypothesized that for T2N0M0 urothelial carcinoma of urinary bladder (UCUB) patients, partial cystectomy (PC) does not differ from radical cystectomy (RC) regarding cancer-specific mortality (CSM).

Methods: Within the Surveillance, Epidemiology and End Results (SEER) database (2004-2021), rates of PC versus RC for T2N0M0 UCUB patients were tabulated. Nearest-neighbor 1:1 propensity score-matching (PSM) for age, sex, tumor size and site, race/ethnicity, chemotherapy, and pelvic lymph node dissection status was applied. Poisson-smoothed cumulative incidence plots depicted 5-year CSM and other-cause mortality (OCM) rates. Uni- and multivariable competing-risks regression (CRR) models were fitted. Sensitivity analyses were performed for patients with tumors ≤ 3 cm, tumors amenable to segmental resection (outside trigone, ureteric orifices, or bladder neck), or both.

Results: Of 5425 T2N0M0 UCUB patients, 412 (7.6%) received PC versus 5013 (92.4%) who received RC. The PC rates decreased from 12.1% in 2004 to 6.2% in 2021 (p < 0.001). After PSM, the 5 year CSM rate was 26.7% for PC versus 28.4% for RC, and after ultivariable CRR, PC was unrelated to CSM rates (multivariable hazard ratio [mHR], 0.9; p = 0.2). In separate sensitivity analyses of 3187 (58.7%) patients with tumors ≤ 3 cm, 2521 (46.5%), patients with tumors amenable to segmental resection, and 1416 (26.1%) patients with both, after reapplication of PSM and additional multivariable adjustment, virtually the same results were observed.

Conclusion: A small proportion of T2N0M0 UCUB patients underwent PC instead of RC. However, for well-selected patients, PC was not associated with worse cancer control outcomes than RC.

T2N0M0型尿路上皮性膀胱癌部分膀胱切除术与根治性膀胱切除术的癌症特异性死亡率。
背景:作者假设对于T2N0M0型尿路上皮性膀胱癌(UCUB)患者,部分膀胱切除术(PC)与根治性膀胱切除术(RC)在癌症特异性死亡率(CSM)方面没有差异。方法:在监测、流行病学和最终结果(SEER)数据库(2004-2021)中,将T2N0M0型UCUB患者的PC率与RC率制成表格。采用年龄、性别、肿瘤大小和部位、种族/民族、化疗和盆腔淋巴结清扫情况的最近邻1:1倾向评分匹配(PSM)。泊松平滑累积发病率图描述了5年CSM和其他原因死亡率(OCM)。拟合了单变量和多变量竞争风险回归(CRR)模型。对肿瘤≤3cm、适合节段性切除(三角外、输尿管口或膀胱颈)或两者兼而有之的患者进行敏感性分析。结果:5425例T2N0M0型UCUB患者中,412例(7.6%)接受PC治疗,5013例(92.4%)接受RC治疗。PC率从2004年的12.1%下降到2021年的6.2% (p < 0.001)。PSM后,PC的5年CSM率为26.7%,而RC为28.4%,多变量CRR后,PC与CSM率无关(多变量风险比[mHR], 0.9;P = 0.2)。在分别对3187例(58.7%)肿瘤≤3cm患者、2521例(46.5%)肿瘤适合节段性切除患者和1416例(26.1%)两种肿瘤均可切除的患者进行敏感性分析后,再次应用PSM并进行额外的多变量调整,观察到几乎相同的结果。结论:一小部分T2N0M0型UCUB患者行PC而非RC。然而,对于精心挑选的患者,PC与癌症控制结果的关系并不比RC差。
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来源期刊
CiteScore
5.90
自引率
10.80%
发文量
1698
审稿时长
2.8 months
期刊介绍: The Annals of Surgical Oncology is the official journal of The Society of Surgical Oncology and is published for the Society by Springer. The Annals publishes original and educational manuscripts about oncology for surgeons from all specialities in academic and community settings.
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