Hollenbeck Brent K, Taub David A, Dunn Rodney L, Wei John T
Department of Urology, University of Michigan, Ann Arbor, USA.
J Urol. 2005 Sep;174(3):1050-4; discussion 1054. doi: 10.1097/01.ju.0000169477.30477.3d.
Partial cystectomy is perceived to be a less morbid, less technically demanding procedure than radical cystectomy, although only select patients (approximately 6% to 10%) are appropriate candidates (solitary tumor in space/time, absence of carcinoma in situ). From a quality of care perspective, overuse of partial cystectomy may signify inappropriate delivery of health care.
Subjects who underwent extirpative treatment for bladder cancer between 1988 and 2000 were identified within the Surveillance, Epidemiology and End Results (SEER, 3,381) registry and the Nationwide Inpatient Sample (NIS, 22,088). Adjusted models were developed to identify clinical factors independently associated with the use of partial cystectomy for bladder cancer treatment within each sample.
Among patients who underwent extirpative surgery for bladder cancer, 18% and 20% of those in SEER and NIS, respectively, underwent partial cystectomy. Significant decreases in use between early and later years were noted in both samples (SEER-22% to 13%, NIS-24% to 17%, both p <0.0001). Partial cystectomy was preferentially used in the elderly, those with stage I disease, females and black patients. Furthermore, partial cystectomy was more commonly provided in rural, nonteaching, low volume hospitals.
Trends in national use of partial cystectomy are consistent between the NIS and SEER with 13% to 17% of patients currently being treated with partial in lieu of radical cystectomy. Partial cystectomy is disproportionately used in certain medical centers (nonteaching, rural, low volume) and patient populations (elderly, black, females, stage I disease) reflecting selective referral or overuse.
部分膀胱切除术被认为是一种比根治性膀胱切除术创伤性更小、技术要求更低的手术，尽管只有特定患者（约6%至10%）适合（肿瘤在空间/时间上孤立，无原位癌）。从医疗质量的角度来看，过度使用部分膀胱切除术可能意味着医疗服务的不当提供。
在监测、流行病学和最终结果（SEER，3381例）登记处和全国住院患者样本（NIS，22088例）中确定了1988年至2000年间接受膀胱癌切除治疗的受试者。建立了调整模型，以确定每个样本中与使用部分膀胱切除术治疗膀胱癌独立相关的临床因素。
在接受膀胱癌切除手术的患者中，SEER和NIS样本中分别有18%和20%的患者接受了部分膀胱切除术。两个样本中均发现早期和后期使用量显著下降（SEER从22%降至13%，NIS从24%降至17%，p均<0.0001）。部分膀胱切除术优先用于老年人、I期疾病患者女性和黑人患者。此外，部分膀胱切除术在农村、非教学、低容量医院中更常进行。
NIS和SEER之间全国范围内部分膀胱切除术的使用趋势一致，目前有13%至17%的患者接受部分膀胱切除术而非根治性膀胱切除术。部分膀胱切除术在某些医疗中心（非教学、农村、低容量）和患者群体（老年人、黑人、女性、I期疾病）中使用比例过高，反映了选择性转诊或过度使用。
