Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 88 South Keyuan Road, Chengdu, 610041, China.
World J Urol. 2024 Nov 2;42(1):619. doi: 10.1007/s00345-024-05329-y.
To compare the oncological outcomes between standard radical cystectomy (SRC) and organ-sparing cystectomy (OSC) in male patients diagnosed with bladder cancer.
Patients with stage Ta-T3 bladder cancer who underwent OSC or SRC were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. The association between preoperative factors and the implementation of OSC was analyzed using logistic regression. Propensity score matching (PSM) was employed to balance baseline characteristics between the two groups. Patients' overall survival (OS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Subgroup analyses based on the T stage were also conducted.
A total of 7264 patients were included, with 96.8% (7033 patients) receiving SRC and 3.2% (231 patients) receiving OSC. Patients with higher T stages and high-grade tumors were less likely to undergo OSC. After PSM, OSC was associated with significantly worse OS and CSS than SRC. Subgroup analysis revealed that OSC did not lead to worse OS and CSS in non-muscle invasive bladder cancer and T2 stage patients, but it resulted in significantly worse outcomes in T3 stage patients.
Our study indicates that OSC is associated with poorer oncological outcomes compared to SRC, particularly in patients with advanced-stage tumors. These findings suggest the need for stringent selection criteria for OSC in bladder cancer patients. Given the negative impact on prognosis, stage T3 should potentially be considered a contraindication for OSC. Further evidence is required to confirm these assertions.
比较男性膀胱癌患者行标准根治性膀胱切除术（SRC）与保留器官性膀胱切除术（OSC）的肿瘤学结局。
从 2004 年至 2015 年，SEER 数据库中筛选出接受 OSC 或 SRC 治疗的 Ta-T3 期膀胱癌患者。采用逻辑回归分析术前因素与 OSC 实施的相关性。采用倾向评分匹配（PSM）平衡两组间的基线特征。采用 Kaplan-Meier 法估计患者的总生存（OS）和癌症特异性生存（CSS）。还进行了基于 T 分期的亚组分析。
共纳入 7264 例患者，96.8%（7033 例）接受 SRC，3.2%（231 例）接受 OSC。T 分期较高和高级别肿瘤患者行 OSC 的可能性较小。PSM 后，OSC 与 SRC 相比，OS 和 CSS 更差。亚组分析显示，在非肌层浸润性膀胱癌和 T2 期患者中，OSC 并未导致 OS 和 CSS 更差，但在 T3 期患者中，OSC 导致的结局明显更差。
与 SRC 相比，OSC 与较差的肿瘤学结局相关，特别是在晚期肿瘤患者中。这些发现提示在膀胱癌患者中，OSC 应严格选择适应证。鉴于对预后的负面影响，T3 期可能应被视为 OSC 的禁忌证。需要进一步的证据来证实这些结论。
