Longoni Mattia, Di Bello Francesco, Rodriguez Peñaranda Natali, Falkenbach Fabian, Marmiroli Andrea, Le Quynh Chi, Tian Zhe, Goyal Jordan A, Longo Nicola, Micali Salvatore, Graefen Markus, Musi Gennaro, Chun Felix K H, Saad Fred, Shariat Shahrokh F, Moschini Marco, Gandaglia Giorgio, Montorsi Francesco, Briganti Alberto, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
BJU Int. 2025 May;135(5):828-834. doi: 10.1111/bju.16622. Epub 2024 Dec 12.
It is not known whether cancer-specific mortality (CSM) differences distinguish radical cystectomy (RC) from trimodal therapy (TMT) in octogenarians harbouring organ-confined (T2N0M0) urothelial cancer of the urinary bladder (UCUB).
Within the Surveillance, Epidemiology, and End Results database (2004-2021), CSM and other-cause mortality (OCM) rates were computed in octogenarian patients with organ-confined UCUB undergoing either TMT or RC. Smoothed cumulative incidence plots depicted 5-year CSM and OCM rates according to RC vs TMT. Competing risks regression (CRR) models were fitted, adjusting for age, gender, and race/ethnicity. Nearest-neighbour 1:1 propensity-score matching (PSM) for age and gender was also applied. Sensitivity analyses were additionally performed, focusing on White patients.
Of 2335 octogenarian patients with T2N0M0 UCUB, 1562 (66.3%) received TMT and 793 (33.7%) received RC. Of those, 2082 (88.4%) were White. TMT rates increased from 53.5% in 2004 to 82.2% in 2021 (P < 0.001). The 5-year CSM rate was 50.1% for TMT vs 31.1% for RC. After multivariable CRR, TMT independently predicted 1.7-fold higher CSM (P < 0.001). After additional PSM, TMT also independently predicted 1.7-fold higher CSM (P < 0.001). In sensitivity analyses exclusively focusing on White patients, almost identical results were recorded.
Rates of TMT have nearly doubled in octogenarian patients with organ-confined UCUB in recent years; however, CSM rates after TMT are also nearly twice as high as those observed after RC. It is crucial to communicate these observations.
对于患有器官局限性（T2N0M0）膀胱尿路上皮癌（UCUB）的八旬老人，尚不清楚癌症特异性死亡率（CSM）差异能否区分根治性膀胱切除术（RC）和三联疗法（TMT）。
在监测、流行病学和最终结果数据库（2004 - 2021年）中，计算接受TMT或RC治疗的患有器官局限性UCUB的八旬老人的CSM和其他原因死亡率（OCM）。平滑累积发病率图描绘了根据RC与TMT的5年CSM和OCM率。拟合竞争风险回归（CRR）模型，并对年龄、性别和种族/民族进行调整。还应用了年龄和性别方面的1:1倾向评分匹配（PSM）最近邻法。另外进行了敏感性分析，重点关注白人患者。
在2335例患有T2N0M0 UCUB的八旬老人中，1562例（66.3%）接受了TMT，793例（33.7%）接受了RC。其中，2082例（88.4%）为白人。TMT的比例从2004年的53.5%上升至2021年的82.2%（P < 0.001）。TMT的5年CSM率为50.1%，而RC为31.1%。经过多变量CRR分析，TMT独立预测CSM高1.7倍（P < 0.001）。经过额外的PSM分析后，TMT也独立预测CSM高1.7倍（P < 0.001）。在仅关注白人患者的敏感性分析中，记录到了几乎相同的结果。
近年来，患有器官局限性UCUB的八旬老人中TMT的比例几乎翻了一番；然而，TMT后的CSM率也几乎是RC后观察到的CSM率的两倍。传达这些观察结果至关重要。
