Mangold Maurin Helen, Nientiedt Malin, Waldbillig Frank, Michel Maurice Stephan, Carl Nicolas, Grüne Britta, Kriegmair Maximilian Christian
Department of Urology and Urosurgery, University Medical Centre Mannheim, Ruprecht Karl University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of Urology, Urological Clinic Planegg, Munich, Germany.
World J Urol. 2025 Mar 29;43(1):196. doi: 10.1007/s00345-025-05566-9.
This study examines oncological and functional outcomes in a subset of patients eligible for trimodal therapy (TMT) within a large radical cystectomy (RC) cohort. It aims to determine whether TMT should be offered to all eligible patients, rather than exclusively to patients with significant comorbidities who are at high perioperative risk.
We conducted a retrospective analysis of 509 patients with urothelial carcinoma (pT1-pT4) who underwent RC between 2014 and 2020. Patients were divided into TMT eligible (n = 74), and TMT ineligible (n = 431) cohorts based on preoperative criteria. Key endpoints included blood loss, operative duration, urinary diversion type, adjuvant chemotherapy, and overall and progression-free survival (OS, PFS). Functional outcomes were assessed using validated quality of life (QoL) questionnaires.
RC patients who were eligible for TMT demonstrated significantly better oncological outcomes, with higher overall survival (OS) (HR: 2.774, p < 0.001) and progression-free survival (PFS) (HR: 3.689, p < 0.001). They also experienced lower intraoperative blood loss (544.59 ml vs. 740.50 ml, p = 0.002) and were more likely to receive continent urinary diversion (55.1% vs. 38.8%, p = 0.01), with nearly 50% undergoing ileal neobladder reconstruction. Adjuvant chemotherapy was administered more frequently in the TMT-ineligible group (20.8% vs. 6.4%, p = 0.003). Apart from a significant difference in the positive support domain of the ISSS (p = 0.01), no significant differences in functional outcomes were observed.
TMT eligible patients undergoing RC have better oncological outcomes and more favourable perioperative parameters compared to TMT ineligible patients. These findings highlight the need for careful patient counselling when considering TMT as an alternative to RC. Future prospective studies are warranted to optimise treatment selection and functional outcome assessment in bladder cancer.
本研究在一个大型根治性膀胱切除术（RC）队列中，对一部分适合三联疗法（TMT）的患者的肿瘤学和功能结局进行了研究。其目的是确定是否应将TMT提供给所有符合条件的患者，而不是仅提供给围手术期风险高且有严重合并症的患者。
我们对2014年至2020年间接受RC的509例尿路上皮癌（pT1 - pT4）患者进行了回顾性分析。根据术前标准，将患者分为适合TMT组（n = 74）和不适合TMT组（n = 431）。主要终点包括失血量、手术时长、尿流改道类型、辅助化疗以及总生存期和无进展生存期（OS，PFS）。使用经过验证的生活质量（QoL）问卷评估功能结局。
适合TMT的RC患者显示出明显更好的肿瘤学结局，总生存期（OS）更高（HR：2.774，p < 0.001）和无进展生存期（PFS）更高（HR：3.689，p < 0.001）。他们术中失血量也更低（544.59毫升对740.50毫升，p = 0.002），并且更有可能接受可控性尿流改道（55.1%对38.8%，p = 0.01），近50%的患者接受回肠新膀胱重建。辅助化疗在不适合TMT的组中应用更频繁（20.8%对6.4%，p = 0.003）。除了国际脊髓损伤神经学分类标准（ISSS）的积极支持领域存在显著差异（p = 0.01）外，未观察到功能结局有显著差异。
与不适合TMT的患者相比，接受RC的适合TMT的患者具有更好的肿瘤学结局和更有利的围手术期参数。这些发现凸显了在考虑将TMT作为RC替代方案时，需要对患者进行仔细咨询。未来有必要进行前瞻性研究，以优化膀胱癌的治疗选择和功能结局评估。
