T2N0M0期尿路上皮膀胱癌行部分膀胱切除术与根治性膀胱切除术的癌症特异性死亡率

Cancer-Specific Mortality of Partial Cystectomy Versus Radical Cystectomy in T2N0M0 Urothelial Bladder Cancer.

作者信息

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

机构信息

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.

出版信息

Ann Surg Oncol. 2025 May 27. doi: 10.1245/s10434-025-17488-2.

DOI:10.1245/s10434-025-17488-2

PMID:40425913

Abstract

BACKGROUND

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).

METHODS

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.

RESULTS

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.

CONCLUSION

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.

摘要

背景

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。

方法

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。

结果

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。