Hinojosa-Gonzalez David E, Saffati Gal, Wahlstedt Eric, Chaput Madeline, Patel Sagar R, Salgado-Garza Gustavo, Kronstedt Shane, Segall Michal R, Angulo-Lozano Juan C, Jones Jeffrey A, Taylor Jennifer M, Slawin Jeremy R
Scott Department of Urology, Baylor College of Medicine, Houston, TX.
University of Kentucky College of Medicine, Lexington, KY.
Urol Oncol. 2025 May;43(5):275-285. doi: 10.1016/j.urolonc.2024.09.024. Epub 2024 Oct 11.
Radical Cystectomy is indicated in muscle-invasive bladder cancer and select cases of nonmuscle invasive bladder cancer. Women often undergo additional reproductive organ removal, greatly impacting sexual function and quality of life. Pelvic organ-preserving radical cystectomy aims to mitigate these effects, but its oncologic outcomes are not well-defined. This presents a meta-analysis of available literature on oncological outcomes of pelvic organ-preserving radical cystectomy in women with muscle invasive disease.
A systematic search across PubMed, Web of Science, Scopus, and Google Scholar was performed to identify studies comparing oncological outcomes between pelvic organ-preserving radical cystectomy and standard radical cystectomy in women with muscle-invasive bladder cancer or high-risk or recurrent nonmuscle invasive cancer. The search included English or Spanish studies, statistically comparing overall survival, cancer-specific survival, and recurrence-free survival. Statistical analysis used Review Manager, employing fixed or random-effects models based on heterogeneity.
Six retrospective studies met inclusion criteria, totaling 597 patients of which 303 received pelvic organ-preserving radical cystectomy and 294 received standard radical cystectomy. Overall Survival was not different between the 2 groups (HR 1.05 [0.77, 1.43]; P = 0.77). Cancer-Specific Survival also was found to be not different between the 2 groups (HR 1.27 [0.86, 1.87]; P = 0.22). Additionally, recurrence-free survival was not different between the 2 groups (HR 0.85 [0.41, 1.75]; P = 0.65. Four of the included studies exhibited a moderate risk of bias, with 1 study demonstrating low risk and the remaining study manifesting a serious risk of bias.
The comparison showed no significant differences in overall survival, cancer-specific survival, or recurrence-free survival rates.
根治性膀胱切除术适用于肌层浸润性膀胱癌以及部分非肌层浸润性膀胱癌病例。女性患者通常还需切除额外的生殖器官，这对其性功能和生活质量产生极大影响。保留盆腔器官的根治性膀胱切除术旨在减轻这些影响，但其肿瘤学结局尚不明确。本文对现有关于保留盆腔器官的根治性膀胱切除术治疗肌层浸润性疾病女性患者肿瘤学结局的文献进行了荟萃分析。
在PubMed、科学网、Scopus和谷歌学术上进行系统检索，以识别比较保留盆腔器官的根治性膀胱切除术与标准根治性膀胱切除术治疗肌层浸润性膀胱癌或高危或复发性非肌层浸润性癌症女性患者肿瘤学结局的研究。检索范围包括英文或西班牙文研究，对总生存率、癌症特异性生存率和无复发生存率进行统计学比较。统计分析使用Review Manager，根据异质性采用固定效应或随机效应模型。
六项回顾性研究符合纳入标准，共计597例患者，其中303例接受了保留盆腔器官的根治性膀胱切除术，294例接受了标准根治性膀胱切除术。两组的总生存率无差异（风险比1.05 [0.77, 1.43]；P = 0.77）。两组的癌症特异性生存率也无差异（风险比1.27 [0.86, 1.87]；P = 0.22）。此外，两组的无复发生存率无差异（风险比0.85 [0.41, 1.75]；P = 0.65）。纳入的四项研究存在中度偏倚风险，一项研究显示低风险，其余一项研究存在严重偏倚风险。
比较结果显示，总生存率、癌症特异性生存率或无复发生存率无显著差异。
