Ping Zheng, Zhan Xiangpeng, Chen Tao, Zheng Yunwei, Jiang Ming, Li Yu, Fu Bin
Department of Urology, Shangrao Municipal Hospital, Shangrao, Jiangxi, China.
Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
J Oncol. 2022 Oct 25;2022:3016725. doi: 10.1155/2022/3016725. eCollection 2022.
Partial cystectomy was investigated as a method of bladder preservation with better disease outcomes than transurethral bladder tumor resection in T1 high-grade bladder cancer patients. . The national Surveillance, Epidemiology, and End Results database (SEER) (2004-2015) were used to obtain patients diagnosed with T1 high-grade bladder cancer, and finally, 25263 patients were enrolled in our study. The Kaplan-Meier method with the log-rank test was performed to analyze the outcome of overall survival (OS) and cancer-specific survival (CSS) between patients undergoing partial cystectomy (PC), transurethral resection of bladder tumor (TURBT), or radical cystectomy (RC). Moreover, the propensity score matching (PSM) and multivariable Cox proportional hazard model were also utilized in the study.
Ultimately, 24635 patients were undergoing TURBT, while 190 and 438 patients were, respectively, assigned to the PC and RC groups. Compared with patients with TURBT, a tendency of a higher proportion of higher older and male patients was observed in the PC group. When matching with RC patients, patients in the PC group were commonly older and had bigger tumor sizes and single tumors (All < 0.05). After 1 : 1 PSM, 190 patients with TURBT and 160 patients receiving PC were selected. In survival analysis, the patients in the PC group had a higher survival probability of both OS and CSS before and after PSM compared with those in the TURBT group. Meanwhile, no significant differences were observed between the RC and PC groups in OS and CSS analysis. Moreover, multivariable Cox regression showed that PC was a protective factor for overall mortality (ACM) and cancer-specific mortality (CSM) compared with TURBT in T1 high-grade patients (All < 0.05).
Patients undergoing partial cystectomy were shown to have a better outcome compared with those with transurethral bladder tumor resection in T1 high-grade bladder cancer patients. Partial cystectomy could be the more worthwhile choice for bladder preservation in T1 high-grade bladder cancer patients.
研究部分膀胱切除术作为一种膀胱保留方法，在T1期高级别膀胱癌患者中是否比经尿道膀胱肿瘤切除术具有更好的疾病预后。使用国家监测、流行病学和最终结果数据库（SEER）（2004 - 2015年）获取诊断为T1期高级别膀胱癌的患者，最终25263例患者纳入本研究。采用Kaplan - Meier法和对数秩检验分析接受部分膀胱切除术（PC）、经尿道膀胱肿瘤切除术（TURBT）或根治性膀胱切除术（RC）患者的总生存期（OS）和癌症特异性生存期（CSS）结局。此外，研究还采用了倾向评分匹配（PSM）和多变量Cox比例风险模型。
最终，24635例患者接受了TURBT，190例和438例患者分别被分配到PC组和RC组。与TURBT患者相比，PC组中年龄较大和男性患者的比例有更高的趋势。与RC患者匹配时，PC组患者通常年龄较大，肿瘤体积更大且为单发肿瘤（均P<0.05）。经过1:1 PSM后，选择了190例TURBT患者和160例接受PC的患者。在生存分析中，PSM前后PC组患者的OS和CSS生存概率均高于TURBT组患者。同时，在OS和CSS分析中，RC组和PC组之间未观察到显著差异。此外，多变量Cox回归显示，在T1期高级别患者中，与TURBT相比，PC是总死亡率（ACM）和癌症特异性死亡率（CSM）的保护因素（均P<0.05）。
在T1期高级别膀胱癌患者中，接受部分膀胱切除术的患者与经尿道膀胱肿瘤切除术的患者相比，预后更好。部分膀胱切除术可能是T1期高级别膀胱癌患者膀胱保留更值得选择的方法。
