Mattia Longoni, Andrea Marmiroli, Fabian Falkenbach, Quynh Chi Le, Michele Nicolazzini, Calogero Catanzaro, Federico Polverino, Jordan A Goyal, Gennaro Musi, 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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Nearest-neighbor 1:1 propensity score matching (PSM) for age, sex, stage, race/ethnicity, and histological subtype was applied. Cumulative incidence plots depicted five-year CSM. Univariable and multivariable competing risks regression (CRR) models were fitted. Sensitivity analyses were performed within squamous cell carcinoma (SCC), small cell carcinoma (small-CC) and adenocarcinoma (ADK).</p><p><strong>Results: </strong>Of 775 NOC non-UCUB patients, 290 (37.4%) received NSM vs. 485 (62.6%) RC. After PSM, five-year CSM rate was 70.4% after NSM vs. 60.6% after RC and NSM was associated with 1.6-fold higher CSM relative to RC (multivariable HR [mHR]: 1.61, p < 0.001). In sensitivity analyses within 253 (32.6%) SCC, after re-applying PSM, five-year CSM rate was 85.0% after NSM vs. 53.3% after RC and NSM was associated with 2.8-fold higher CSM relative to RC (mHR: 2.80, p < 0.001). Conversely, within 216 (27.9%) small-CC and 135 (17.4%) ADK patients, CSM after NSM did not differ from CSM after RC (54.3 vs. 62.5%, mHR: 0.85; 69.8 vs. 71.7%, mHR: 1.0; all p > 0.05).</p><p><strong>Conclusion: </strong>In NOC non-UCUB patients, NSM is associated with higher CSM than RC. 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引用次数: 0
摘要
我们假设在非器官限制性（NOC， T3-4和/或N1-3）非尿路上皮性膀胱癌（non-UCUB）患者中，保留膀胱的非手术治疗（NSM）提供与根治性膀胱切除术（RC）相当的癌症特异性死亡率（CSM）。方法：在SEER数据库（2004-2021）中，将NOC非ucub患者中NSM与RC的使用比例进行了列表。采用年龄、性别、分期、种族/民族和组织学亚型的最近邻1:1倾向评分匹配（PSM）。累积发病率图描绘了5年CSM。拟合单变量和多变量竞争风险回归（CRR）模型。在鳞状细胞癌（SCC）、小细胞癌（small- cc）和腺癌（ADK）中进行敏感性分析。结果：在775例NOC非ucub患者中，290例（37.4%）接受了NSM， 485例（62.6%）接受了RC。PSM后，NSM后5年的CSM率为70.4%，而RC后为60.6%，NSM与CSM的相关性为RC的1.6倍（多变量比[mHR]: 1.61, p 0.05）。结论：在NOC非ucub患者中，NSM与CSM的相关性高于RC。根据组织学亚型的亚组分析表明，这些差异几乎完全来自SCC患者，而不是来自小cc和ADK患者。
Oncological outcomes after non-surgical management versus radical cystectomy in non-organ-confined non-urothelial bladder cancer.
Introduction: We hypothesized that among non-organ-confined (NOC, T3-4 and/or N1-3) non-urothelial carcinoma of urinary bladder (non-UCUB) patients, bladder-sparing non-surgical management (NSM) provides cancer-specific mortality (CSM) rates comparable to those of radical cystectomy (RC).
Methods: Within the SEER database (2004-2021) rates of NSM vs. RC use in NOC non-UCUB patients were tabulated. Nearest-neighbor 1:1 propensity score matching (PSM) for age, sex, stage, race/ethnicity, and histological subtype was applied. Cumulative incidence plots depicted five-year CSM. Univariable and multivariable competing risks regression (CRR) models were fitted. Sensitivity analyses were performed within squamous cell carcinoma (SCC), small cell carcinoma (small-CC) and adenocarcinoma (ADK).
Results: Of 775 NOC non-UCUB patients, 290 (37.4%) received NSM vs. 485 (62.6%) RC. After PSM, five-year CSM rate was 70.4% after NSM vs. 60.6% after RC and NSM was associated with 1.6-fold higher CSM relative to RC (multivariable HR [mHR]: 1.61, p < 0.001). In sensitivity analyses within 253 (32.6%) SCC, after re-applying PSM, five-year CSM rate was 85.0% after NSM vs. 53.3% after RC and NSM was associated with 2.8-fold higher CSM relative to RC (mHR: 2.80, p < 0.001). Conversely, within 216 (27.9%) small-CC and 135 (17.4%) ADK patients, CSM after NSM did not differ from CSM after RC (54.3 vs. 62.5%, mHR: 0.85; 69.8 vs. 71.7%, mHR: 1.0; all p > 0.05).
Conclusion: In NOC non-UCUB patients, NSM is associated with higher CSM than RC. Subgroup analyses according to histological subtypes suggest that these differences virtually exclusively originated from SCC patients but not from their small-CC and ADK counterparts.
期刊介绍：
International Urology and Nephrology publishes original papers on a broad range of topics in urology, nephrology and andrology. The journal integrates papers originating from clinical practice.
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