Al-Kohlany Khaled, Al-Maleki Amal, Al-Shami Majdi, Hussein Hani, Ahmed Faisal
Department of Urology, General Military Hospital, Sana'a.
Department of Obstetrics and Gynecology, Palestine Hospital for Motherhood and Childhood, Sana'a.
Arch Ital Urol Androl. 2025 Jun 30;97(2):13760. doi: 10.4081/aiua.2025.13760. Epub 2025 May 5.
The lack of a cohesive diagnostic and therapeutic framework for muscle-invasive bladder cancer (MIBC) in Yemen has resulted in significant variability in patient care. This study evaluates oncological outcomes and survival rates after radical cystectomy (RC) for MIBC patients in Yemen.
We conducted a retrospective analysis of 300 MIBC patients who underwent RC between 2006 and 2020. Demographics, histopathological findings, and survival data were meticulously collected. Kaplan-Meier survival analysis estimated survival probabilities, while prognostic factors were evaluated using the log-rank test.
The median patient age was 67 years (IQR 65-70), with a male predominance (n=184, 61.3%). Ileal loop reconstruction was the primary method of urinary diversion (n=234, 78.0%). Urothelial carcinoma was the predominant diagnosis (n=246, 82.0%), followed by squamous cell carcinoma (n=42, 14.0%). Postoperative complications occurred in 93 patients (31.0%), primarily Grade I (n=61, 20.3%). Overall survival was 71.7% (n 215), with 28.3% mortality due to non-cancer-related (n=43, 14.3%) and bladder cancer-related causes (n=35, 11.7%). The median overall survival was 191 months, with 1-year, 3-year, 5-year, and 10-year survival rates of 99%, 93%, 88%, and 82%, respectively. In the multivariate analysis, non-ileal conduit diversion (Hazard Ratio [HR] 5.21, 95% Confidence Interval [CI]: 1.80-15.00, p=0.003), Stage IV disease (HR 2.76, 95% CI: 1.01-7.61, p=0.050), lymph node positivity (HR 2.92, 95% CI: 1.15-7.42, p=0.022), and squamous cell carcinoma (HR 3.09, 95% CI: 1.25-7.63, p=0.022) were identified as predictors of mortality.
This study highlights the urgent need for improved bladder cancer care in Yemen. Late-stage diagnosis and suboptimal surgical methods critically affect survival. Addressing these issues requires prioritizing early detection and standardized surgical techniques to develop effective care pathways for MIBC patients.
也门缺乏针对肌层浸润性膀胱癌（MIBC）的连贯诊断和治疗框架，导致患者护理存在显著差异。本研究评估了也门MIBC患者行根治性膀胱切除术（RC）后的肿瘤学结局和生存率。
我们对2006年至2020年间接受RC的300例MIBC患者进行了回顾性分析。精心收集了人口统计学、组织病理学结果和生存数据。采用Kaplan-Meier生存分析估计生存概率，使用对数秩检验评估预后因素。
患者中位年龄为67岁（四分位间距65 - 70岁），男性占优势（n = 184，61.3%）。回肠袢重建是主要的尿流改道方法（n = 234，78.0%）。尿路上皮癌是主要诊断（n = 246，82.0%），其次是鳞状细胞癌（n = 42，14.0%）。93例患者（31.0%）发生术后并发症，主要为I级（n = 61，20.3%）。总生存率为71.7%（n = 215），28.3%的死亡归因于非癌症相关原因（n = 43，14.3%）和膀胱癌相关原因（n = 35，11.7%）。中位总生存期为191个月，1年、3年、5年和10年生存率分别为99%、93%、88%和82%。在多变量分析中，非回肠导管改道（风险比[HR] 5.21，95%置信区间[CI]：1.80 - 15.00，p = 0.003）、IV期疾病（HR 2.76，95% CI：1.01 - 7.61，p = 0.050）、淋巴结阳性（HR 2.92，95% CI：1.15 - 7.42，p = 0.022）和鳞状细胞癌（HR 3.09，95% CI：1.25 - 7.63，p = 0.022）被确定为死亡的预测因素。
本研究强调了也门改善膀胱癌护理的迫切需求。晚期诊断和次优手术方法严重影响生存率。解决这些问题需要优先进行早期检测并采用标准化手术技术，以制定针对MIBC患者的有效护理路径。
