Avudaiappan Arjun Pon, Prabhakar Pushan, Fleischmann Benjamin, Rubens Muni, Garje Rohan, Ozambela Manuel, Gomez Christopher, Manoharan Murugesan
Department of Urologic Oncology Surgery, Miami Cancer Institute, Miami, FL, USA.
Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
Transl Androl Urol. 2025 Feb 28;14(2):280-288. doi: 10.21037/tau-24-602. Epub 2025 Feb 25.
The gold standard treatment for localized muscle-invasive bladder cancer (MIBC) is neoadjuvant chemotherapy with radical cystectomy (RC). Guidelines suggest concurrent chemoradiation (CRT) could be considered as an alternative, and partial cystectomy (PC) may be considered in carefully selected individuals. The bladder preservation strategies are gaining popularity, and due to the concerns about morbidity associated with RC and limited life expectancy, the octogenarian population is exploring strategies that help preserve bladder function. Hence, it is crucial to understand the outcome of various bladder preservation strategies. Using the National Cancer Database (NCDB), we compared the overall survival (OS) of octogenarians treated with PC and CRT.
We retrospectively evaluated the octogenarians with localized MIBC (cT2N0M0) ≤5 cm and urothelial histology between 2004 and 2018. Our analytic cohorts were the PC cohort, which included patients who underwent PC, and the CRT cohort, which included patients who received chemotherapy and radiotherapy within a 90-day timeframe. After propensity-matching with race and ethnicity, gender, facility type, median income, comorbidity index, and tumor grade, we compared the OS between PC and CRT cohorts.
A total of 1,038 were octogenarians who met our selection criteria. Among them, 248 (23.8%) underwent PC, and 790 (76.2%) received CRT. In the PC cohort, tumors were located predominantly in the dome (34.3%) and anterior wall (10.5%), while in the CRT cohort, tumors were in the trigone (8.4%), lateral (22.0%) and posterior walls (10.6%). The median OS for the matched PC and CRT cohort was 38.3 and 32.9 months, respectively (P=0.66). Multivariate Cox regression showed no difference in survival hazards between PC and CRT [hazard ratio =1.07 (95% confidence interval: 0.82-1.39)] (P=0.63).
Our study comparing PC and CRT in octogenarians with T2 ≤5 cm tumors showed that PC had comparable OS to CRT. Therefore, PC can be considered a viable option in carefully selected octogenarians.
局部肌肉浸润性膀胱癌（MIBC）的金标准治疗方法是新辅助化疗联合根治性膀胱切除术（RC）。指南建议同步放化疗（CRT）可作为一种替代方案，对于经过精心挑选的患者可考虑行部分膀胱切除术（PC）。膀胱保留策略越来越受欢迎，并且由于对RC相关发病率的担忧以及预期寿命有限，八旬老人群体正在探索有助于保留膀胱功能的策略。因此，了解各种膀胱保留策略的结果至关重要。利用国家癌症数据库（NCDB），我们比较了接受PC和CRT治疗的八旬老人的总生存期（OS）。
我们回顾性评估了2004年至2018年间患有局限性MIBC（cT2N0M0）且肿瘤最大径≤5 cm以及尿路上皮组织学类型的八旬老人。我们的分析队列包括PC队列（包括接受PC的患者）和CRT队列（包括在90天内接受化疗和放疗的患者）。在按种族和民族、性别、医疗机构类型、收入中位数、合并症指数和肿瘤分级进行倾向匹配后，我们比较了PC和CRT队列之间的OS。
共有1038名八旬老人符合我们的入选标准。其中，248名（23.8%）接受了PC，790名（76.2%）接受了CRT。在PC队列中，肿瘤主要位于穹窿部（34.3%）和前壁（10.5%），而在CRT队列中，肿瘤位于三角区（8.4%）、侧壁（22.0%）和后壁（10.6%）。匹配后的PC和CRT队列的中位OS分别为38.3个月和32.9个月（P = 0.66）。多因素Cox回归显示PC和CRT之间的生存风险无差异[风险比 = 1.07（95%置信区间：0.82 - 1.39）]（P = 0.63）。
我们对肿瘤最大径≤5 cm的八旬老人进行PC和CRT比较的研究表明，PC与CRT的OS相当。因此，对于经过精心挑选的八旬老人，PC可被视为一种可行的选择。
