Department of Urology, Chongqing University Fuling Hospital, No.2 Gaosuntang Road, Fuling District, Chongqing, 408000, China.
World J Surg Oncol. 2024 Aug 24;22(1):218. doi: 10.1186/s12957-024-03502-6.
Pelvic organ-preserving radical cystectomy (POPRC) has been reported to result in a better postoperative quality of life in female with bladder cancer compared to standard radical cystectomy (SRC). However, its oncological outcomes remain a concern.
Female patients with bladder cancer who underwent POPRC or SRC were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression was used to identify predictors of POPRC usage. To avoid the potential impact of baseline differences between groups on survival, a 1:2 propensity score matching (PSM) was implemented. After that, Kaplan-Meier curves and Log-rank tests were used to determine the significance of overall survival (OS) differences between patients in the SRC group and POPRC group. Finally, subgroup analysis based on predetermined indicators was performed.
A total of 2193 patients were included with a median follow-up of 53 months, of whom 233 (10.6%) received POPRC and 1960 (89.4%) received SRC. No definitive predictors of POPRC were identified. Before PSM, POPRC resulted in comparable OS to SRC (HR = 1.09, p = 0.309), while after PSM, POPRC was associated with significantly worse OS (HR = 1.23, p = 0.038). In subgroup analyses, POPRC led to non-inferior OS (HR = 1.18, 95%CI 0.71-1.95, p = 0.531) in patients with non-muscle invasive bladder cancer (NMIBC) and T2 patients (HR = 1.07, p = 0.669), but significantly worse OS in T3 patients (HR = 1.41, p = 0.02).
Currently, patients undergoing POPRC have not undergone strict screening, and candidates for POPRC should have more stringent criteria in the future to achieve satisfactory oncological outcomes. However, flaws in the study make more evidence needed to support our findings.
与标准根治性膀胱切除术（SRC）相比，保留盆腔器官的根治性膀胱切除术（POPRC）可使女性膀胱癌患者术后生活质量更好。然而，其肿瘤学结果仍令人担忧。
从监测、流行病学和最终结果（SEER）数据库中确定接受 POPRC 或 SRC 的女性膀胱癌患者。采用逻辑回归来确定 POPRC 使用的预测因素。为了避免组间基线差异对生存的潜在影响，实施了 1:2 倾向评分匹配（PSM）。之后，使用 Kaplan-Meier 曲线和 Log-rank 检验来确定 SRC 组和 POPRC 组患者总体生存率（OS）差异的显著性。最后，根据预定指标进行亚组分析。
共纳入 2193 例患者，中位随访时间为 53 个月，其中 233 例（10.6%）接受 POPRC，1960 例（89.4%）接受 SRC。未确定 POPRC 的明确预测因素。PSM 前，POPRC 的 OS 与 SRC 相当（HR=1.09，p=0.309），而 PSM 后，POPRC 与 OS 显著相关更差（HR=1.23，p=0.038）。在亚组分析中，POPRC 在非肌层浸润性膀胱癌（NMIBC）和 T2 患者中导致非劣效 OS（HR=1.18，95%CI 0.71-1.95，p=0.531），但在 T3 患者中导致 OS 更差（HR=1.41，p=0.02）。
目前，接受 POPRC 的患者未经过严格筛选，未来 POPRC 的候选者应具有更严格的标准，以实现满意的肿瘤学结果。然而，研究中的缺陷需要更多的证据来支持我们的发现。
