Longoni Mattia, Marmiroli Andrea, Falkenbach Fabian, Le Quynh Chi, Nicolazzini Michele, Catanzaro Calogero, Polverino Federico, Tian Zhe, Goyal Jordan A, Ferro Matteo, Graefen Markus, Chun Felix K H, Volpe Alessandro, Schiavina Riccardo, Longo Nicola, 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, Québec, Canada.
Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy.
Ann Surg Oncol. 2025 May 27. doi: 10.1245/s10434-025-17488-2.
The authors hypothesized that for T2N0M0 urothelial carcinoma of urinary bladder (UCUB) patients, partial cystectomy (PC) does not differ from radical cystectomy (RC) regarding cancer-specific mortality (CSM).
Within the Surveillance, Epidemiology and End Results (SEER) database (2004-2021), rates of PC versus RC for T2N0M0 UCUB patients were tabulated. Nearest-neighbor 1:1 propensity score-matching (PSM) for age, sex, tumor size and site, race/ethnicity, chemotherapy, and pelvic lymph node dissection status was applied. Poisson-smoothed cumulative incidence plots depicted 5-year CSM and other-cause mortality (OCM) rates. Uni- and multivariable competing-risks regression (CRR) models were fitted. Sensitivity analyses were performed for patients with tumors ≤ 3 cm, tumors amenable to segmental resection (outside trigone, ureteric orifices, or bladder neck), or both.
Of 5425 T2N0M0 UCUB patients, 412 (7.6%) received PC versus 5013 (92.4%) who received RC. The PC rates decreased from 12.1% in 2004 to 6.2% in 2021 (p < 0.001). After PSM, the 5 year CSM rate was 26.7% for PC versus 28.4% for RC, and after ultivariable CRR, PC was unrelated to CSM rates (multivariable hazard ratio [mHR], 0.9; p = 0.2). In separate sensitivity analyses of 3187 (58.7%) patients with tumors ≤ 3 cm, 2521 (46.5%), patients with tumors amenable to segmental resection, and 1416 (26.1%) patients with both, after reapplication of PSM and additional multivariable adjustment, virtually the same results were observed.
A small proportion of T2N0M0 UCUB patients underwent PC instead of RC. However, for well-selected patients, PC was not associated with worse cancer control outcomes than RC.
作者推测，对于T2N0M0期膀胱尿路上皮癌（UCUB）患者，部分膀胱切除术（PC）与根治性膀胱切除术（RC）在癌症特异性死亡率（CSM）方面并无差异。
在监测、流行病学和最终结果（SEER）数据库（2004 - 2021年）中，统计T2N0M0期UCUB患者接受PC与RC的比例。对年龄、性别、肿瘤大小和部位、种族/民族、化疗以及盆腔淋巴结清扫状态进行1:1倾向评分匹配（PSM）。泊松平滑累积发病率图描绘了5年CSM率和其他原因死亡率（OCM）。拟合单变量和多变量竞争风险回归（CRR）模型。对肿瘤≤3 cm、适合节段性切除（三角区、输尿管口或膀胱颈以外）的肿瘤患者或两者兼具的患者进行敏感性分析。
在5425例T2N0M0期UCUB患者中，412例（7.6%）接受了PC，5013例（92.4%）接受了RC。PC比例从2004年的12.1%降至2021年的6.2%（p < 0.001）。PSM后，PC的5年CSM率为26.7%，RC为28.4%，多变量CRR后，PC与CSM率无关（多变量风险比[mHR]，0.9；p = 0.2）。在对3187例（58.7%）肿瘤≤3 cm的患者、2521例（46.5%）适合节段性切除的肿瘤患者以及1416例（26.1%）两者兼具的患者进行的单独敏感性分析中，重新应用PSM并进行额外的多变量调整后，观察到了几乎相同的结果。
一小部分T2N0M0期UCUB患者接受了PC而非RC。然而，对于精心挑选的患者，PC与RC相比，癌症控制结果并不更差。
