Yu-Xuan Yang, Gui-Chen Ye, Jia-Cheng Xiang, Kuang-Di Luo, Shao-Gang Wang , Qi-Dong Xia
{"title":"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","authors":"Yu-Xuan Yang, Gui-Chen Ye, Jia-Cheng Xiang, Kuang-Di Luo, Shao-Gang Wang , Qi-Dong Xia","doi":"10.1016/j.clgc.2024.102257","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Materials and Methods</h3><div>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.</div></div><div><h3>Result</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102257"},"PeriodicalIF":2.3000,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Differential Analysis of Surgical Treatment Modalities in T2N0M0 Bladder Cancer Patients: A Novel Propensity Score-Based Cohort Study\",\"authors\":\"Yu-Xuan Yang, Gui-Chen Ye, Jia-Cheng Xiang, Kuang-Di Luo, Shao-Gang Wang , Qi-Dong Xia\",\"doi\":\"10.1016/j.clgc.2024.102257\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>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.</div></div><div><h3>Materials and Methods</h3><div>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.</div></div><div><h3>Result</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>\",\"PeriodicalId\":10380,\"journal\":{\"name\":\"Clinical genitourinary cancer\",\"volume\":\"23 1\",\"pages\":\"Article 102257\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-11-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical genitourinary cancer\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1558767324002271\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical genitourinary cancer","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1558767324002271","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
Differential Analysis of Surgical Treatment Modalities in T2N0M0 Bladder Cancer Patients: A Novel Propensity Score-Based Cohort Study
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.
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.