Luzzago Stefano, Palumbo Carlotta, Rosiello Giuseppe, Knipper Sophie, Pecoraro Angela, Deuker Marina, Mistretta Francesco Alessandro, Tian Zhe, Musi Gennaro, Montanari Emanuele, Shariat Shahrokh F, Saad Fred, Briganti Alberto, de Cobelli Ottavio, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada; Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada; Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy.
Clin Genitourin Cancer. 2020 Apr;18(2):117-128.e5. doi: 10.1016/j.clgc.2019.10.016. Epub 2019 Oct 16.
The present study tested cancer-specific (CSM) and overall mortality (OM) after partial cystectomy (PC) for variant histology bladder cancer (non-urothelial carcinoma of the urinary bladder UCUB), relative to UCUB and relative to radical cystectomy (RC).
Within the Surveillance, Epidemiology, and End Results registry (2001-2016), we identified patients with stage T1-T2N0M0 non-UCUB and UCUB who had undergone PC or RC. Non-UCUB included adenocarcinoma, squamous carcinoma, neuroendocrine carcinoma, and other histologic subtypes. First, CSM and OM after PC were compared between the non-UCUB and UCUB groups. Second, CSM and OM after PC were compared with RC in the non-UCUB group. Kaplan Meier plots and multivariable Cox regression models were used before and after inverse probability of treatment weighting.
Overall, 248 patients (16.3%) treated with PC had had non-UCUB. Of the 248 cases, 115 (46.5%), 50 (20%), 34 (14%), and 49 (19.5%) were adenocarcinoma, squamous carcinoma, neuroendocrine carcinoma, and other histologic subtypes, respectively. The comparison between PC in the non-UCUB and PC in the UCUB group showed higher CSM (hazard ratio, 1.4; P = .03) but the same OM rates (hazard ratio, 1.1; P = .7) in the non-UCUB group. The comparison between PC and RC for the non-UCUB group showed no CSM or OM differences.
PC for non-UCUB was associated with higher CSM compared with PC for UCUB. However, PC instead of RC for select patients with non-UCUB appears not to undermine cancer-control outcomes. Thus, the excess CSM is probably unrelated to cystectomy type but could originate from differences in the tumor biology. These results could act as hypothesis generating for the design of future trials.
本研究检测了膀胱部分切除术（PC）治疗变异组织学类型膀胱癌（非尿路上皮性膀胱癌，UCUB）后的癌症特异性死亡率（CSM）和总死亡率（OM），并与UCUB以及根治性膀胱切除术（RC）进行比较。
在监测、流行病学和最终结果登记处（2001 - 2016年）中，我们确定了接受PC或RC治疗的T1 - T2N0M0期非UCUB和UCUB患者。非UCUB包括腺癌、鳞癌、神经内分泌癌和其他组织学亚型。首先，比较非UCUB组和UCUB组PC后的CSM和OM。其次，在非UCUB组中比较PC和RC后的CSM和OM。在治疗权重逆概率前后使用Kaplan Meier曲线和多变量Cox回归模型。
总体而言，248例（16.3%）接受PC治疗的患者患有非UCUB。在这248例病例中，分别有115例（46.5%）、50例（20%）、34例（14%）和4例（19.5%）为腺癌、鳞癌、神经内分泌癌和其他组织学亚型。非UCUB组PC与UCUB组PC的比较显示，非UCUB组的CSM较高（风险比，1.4；P = 0.03），但OM率相同（风险比，1.1；P = 0.7）。非UCUB组PC与RC的比较显示CSM和OM无差异。
与UCUB的PC相比，非UCUB的PC与更高的CSM相关。然而，对于部分非UCUB患者，选择PC而非RC似乎不会损害癌症控制结果。因此，额外的CSM可能与膀胱切除术类型无关，而可能源于肿瘤生物学差异。这些结果可为未来试验的设计提供假设。
