Liu Jianyong, Lai Shicong, Lu Na, Luo Shuhang, Tang Runhua, Li Lin, Wu Pengjie, Wang Dongwen, Tian Jun
Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
Department of Urology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, People's Republic of China.
Eur J Med Res. 2025 Jul 2;30(1):564. doi: 10.1186/s40001-025-02658-5.
To evaluate the effects of surgical interventions on individuals diagnosed with bladder neuroendocrine carcinoma (BNEC).
Data were gathered from the Surveillance, Epidemiology, and End Results (SEER) database for this retrospective analysis. No-surgery procedures included TURBT, cryotherapy, excisional biopsy, or partial cystectomy. Surgery was categorized as cystectomy, radical cystectomy, or a more complex surgical intervention, such as exenteration. A propensity score overlap weight (PSOW) analysis was performed to adjust statistical influences between the two groups. Prognostic factors related to cancer-specific survival (CSS) and overall survival (OS) were assessed using Cox proportional hazard regression.
A total of 2,442 participants were divided into two groups: no-surgery group (n = 1860) and surgery group (n = 582). Individuals in the no-surgery cohort showed a preference for radiation therapy (29.5% compared to 6.7%), whereas individuals in the surgery cohort were more prone to receiving chemotherapy (71.5% compared to 56.6%) as part of their treatment regimen. Surgery was determined to have a strong correlation with increased rates of OS (hazard ratio (HR) = 0.564, 95% confidence interval (CI) = 0.497-0.639, P < 0.001) and CSS (HR = 0.628, 95% CI 0.539-0.732, P < 0.001) results in BNEC patients. After PSOW, 307 patients were selected for each group. Surgical intervention demonstrated a notable enhancement in OS (P < 0.001) and CSS (P < 0.001) than those patients in the no-surgery group. Among the chemotherapy population, the median survival of patients in the surgery group was significantly higher when compared to those in the no-surgery group. Furthermore, individuals diagnosed with stage I (OS, HR = 0.202, 95% CI 0.112-0.366, P < 0.001; CSS HR = 0.198, 95% CI 0.083-0.472, P < 0.001) and II (OS HR = 0.417, 95% CI 0.331-0.525, P < 0.001; CSS HR = 0.415, 95% CI 0.307-0.561, P < 0.001) tumors who underwent surgical procedures exhibited improved long-term survival rates, whereas no surgical advantage was evident in later stages.
In the early stages of BNEC, individuals who undergo surgery experience improved survival rates. Therefore, it is important to carefully consider surgical treatment for patients with advanced BNEC.
评估手术干预对诊断为膀胱神经内分泌癌（BNEC）患者的影响。
本回顾性分析的数据来自监测、流行病学和最终结果（SEER）数据库。非手术程序包括经尿道膀胱肿瘤切除术（TURBT）、冷冻疗法、切除活检或部分膀胱切除术。手术分为膀胱切除术、根治性膀胱切除术或更复杂的手术干预，如脏器清除术。进行倾向评分重叠权重（PSOW）分析以调整两组之间的统计影响。使用Cox比例风险回归评估与癌症特异性生存（CSS）和总生存（OS）相关的预后因素。
总共2442名参与者被分为两组：非手术组（n = 1860）和手术组（n = 582）。非手术队列中的个体更倾向于接受放射治疗（29.5%，而手术队列中为6.7%），而手术队列中的个体作为其治疗方案的一部分更倾向于接受化疗（71.5%，而手术队列中为56.6%）。确定手术与BNEC患者的OS率增加（风险比（HR）= 0.564，95%置信区间（CI）= 0.497 - 0.639，P < 0.001）和CSS（HR = 0.628，95% CI 0.539 - 0.732，P < 0.001）结果密切相关。PSOW后，每组选择307名患者。与非手术组患者相比，手术干预在OS（P < 0.001）和CSS（P < 0.001）方面有显著提高。在化疗人群中，手术组患者的中位生存期明显高于非手术组。此外，诊断为I期（OS，HR = 0.202，95% CI 0.112 - 0.366，P < 0.001；CSS HR = 0.198，95% CI 0.083 - 0.472，P < 0.001）和II期（OS HR = 0.417，95% CI 0.331 - 0.525，P < 0.001；CSS HR = 0.415，95% CI 0.307 - 0.561，P < 0.001）肿瘤且接受手术的患者长期生存率提高，而在晚期则没有明显的手术优势。
在BNEC的早期阶段，接受手术的个体生存率提高。因此，对于晚期BNEC患者，仔细考虑手术治疗很重要。
