Department of Urology, Columbia University Medical Center, New York, NY.
Department of Urology, Columbia University Medical Center, New York, NY.
Urol Oncol. 2023 Aug;41(8):356.e11-356.e18. doi: 10.1016/j.urolonc.2023.04.017. Epub 2023 May 18.
While radical cystectomy (RC) is the standard of care for muscle invasive bladder cancer (MIBC), partial cystectomy (PC) is an effective alternative in select patients. We sought to examine differences in survival for RC and PC in a hospital-based registry.
We identified patients diagnosed with cT2-4 bladder cancer who underwent RC or PC from 2003 to 2015 in the National Cancer Database (NCDB). Using inverse probability treatment weighting (IPTW) to control for known confounders, we compared the primary outcome of overall survival (OS) in patients who underwent RC vs. PC. Kaplan-Meier survival analysis, univariable and multivariable Cox proportional hazards modeling were used. We performed a secondary survival analysis for a subcohort of patients with cT2, cN0, tumor size ≤5 cm, and no concurrent carcinoma in situ (CIS), who may be optimal candidates for PC.
A total of 22,534 patients met inclusion criteria, of which 6.9% (1,457) underwent PC. RC had longer median OS than PC (67.8 vs. 54.1 months) and on Cox regression analysis (HR 0.88, 95% CI, 0.80-0.95, P = 0.002). However, in our subcohort, there was no difference in OS between RC and PC (HR 1.02, 95% CI, 0.9-1.2, P = 0.74). PC was associated with increased time from surgery to any systemic therapy or death in the subcohort.
Among patients with clinically organ-confined MIBC, PC appears to afford similar survival outcomes to RC in a large national data set. The safety and tolerability of PC may warrant consideration in highly selected patients.
根治性膀胱切除术（RC）是肌层浸润性膀胱癌（MIBC）的标准治疗方法，但在某些患者中，部分膀胱切除术（PC）是一种有效的替代方法。我们旨在通过医院为基础的登记处，检查 RC 和 PC 在患者生存方面的差异。
我们从国家癌症数据库（NCDB）中确定了 2003 年至 2015 年期间接受 RC 或 PC 的 cT2-4 膀胱癌患者。通过逆概率治疗加权（IPTW）控制已知混杂因素，我们比较了接受 RC 与 PC 的患者的主要结局（总生存（OS））。采用 Kaplan-Meier 生存分析、单变量和多变量 Cox 比例风险模型进行分析。我们对可能是 PC 最佳候选者的 cT2、cN0、肿瘤大小≤5cm 且无同时存在原位癌（CIS）的亚组患者进行了二次生存分析。
共有 22534 名患者符合纳入标准，其中 6.9%（1457 名）接受了 PC。RC 的中位 OS 长于 PC（67.8 与 54.1 个月），且在 Cox 回归分析中（HR 0.88，95%CI，0.80-0.95，P=0.002）。然而，在我们的亚组中，RC 和 PC 之间的 OS 无差异（HR 1.02，95%CI，0.9-1.2，P=0.74）。在亚组中，PC 与手术至任何系统性治疗或死亡的时间延长相关。
在具有临床器官局限性 MIBC 的患者中，PC 在大型全国性数据集中似乎与 RC 提供相似的生存结果。PC 的安全性和耐受性可能值得在高度选择的患者中考虑。
