Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Sichuan, 610041, China.
Clin Transl Oncol. 2024 Feb;26(2):446-455. doi: 10.1007/s12094-023-03264-9. Epub 2023 Jun 30.
Due to its unique advantages over radical cystectomy (RC), trimodality therapy (TMT) is increasingly being utilized by patients diagnosed with muscle-invasive bladder cancer (MIBC) who are not suitable for or refuse RC. However, achieving a satisfactory oncological outcome with TMT requires strict patient selection criteria, and the comparative oncological outcomes of TMT versus RC remain controversial.
Patients diagnosed with non-metastatic MIBC who underwent TMT or RC were identified from the SEER database during 2004-2015. Before one-to-one propensity score matching (PSM), logistic regression was utilized to identify predictors of TMT. After matching, K-M curves were generated to estimate cancer-specific survival (CSS) and overall survival (OS) with log-rank to test the significance. Finally, we conducted univariate and multivariate Cox analyses to identify independent prognostic factors for CSS and OS.
The RC and TMT groups included 5812 and 1260 patients, respectively, and the TMT patients were significantly older than the RC patients. Patients with advanced age, separated, divorced, or widowed (SDW) or unmarried marital status (married as reference), and larger tumor size (< 40 mm as reference) were more likely to be treated with TMT. After PSM, TMT was found to be associated with worse CSS and OS, and it was identified as an independent risk factor for both CSS and OS.
MIBC patients may not be carefully evaluated prior to TMT, and some non-ideal candidates underwent TMT. TMT resulted in worse CSS and OS in the contemporary era, but these results may be biased. Strict TMT candidate criteria and TMT treatment modality should be required.
由于其相较于根治性膀胱切除术（RC）的独特优势，对于不适合或拒绝 RC 的肌层浸润性膀胱癌（MIBC）患者，越来越多的患者选择接受三联疗法（TMT）。然而，要想通过 TMT 获得令人满意的肿瘤学疗效，需要严格的患者选择标准，且 TMT 相较于 RC 的肿瘤学疗效仍存在争议。
本研究从 2004 年至 2015 年的 SEER 数据库中，筛选出接受 TMT 或 RC 治疗的非转移性 MIBC 患者。在进行一对一倾向评分匹配（PSM）之前，我们采用逻辑回归确定 TMT 的预测因素。匹配后，采用 K-M 曲线估计癌症特异性生存率（CSS）和总生存率（OS），并采用对数秩检验来测试差异的显著性。最后，我们进行单变量和多变量 Cox 分析，以确定 CSS 和 OS 的独立预后因素。
RC 组和 TMT 组分别纳入 5812 例和 1260 例患者，TMT 组患者明显比 RC 组患者年龄更大。高龄、离异/丧偶（SDW）或未婚（以已婚为参考）以及肿瘤较大（<40mm 为参考）的患者更有可能接受 TMT。PSM 后，TMT 与较差的 CSS 和 OS 相关，且是 CSS 和 OS 的独立危险因素。
在接受 TMT 之前，MIBC 患者可能未被仔细评估，部分不理想的患者接受了 TMT。在当代，TMT 导致较差的 CSS 和 OS，但这些结果可能存在偏倚。严格的 TMT 候选标准和 TMT 治疗方式应被要求。
