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.
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.