背景:据报道,与标准根治性膀胱切除术(SRC)相比,保留盆腔器官的根治性膀胱切除术(POPRC)可提高膀胱癌女性的术后生活质量。然而,其肿瘤学结果仍然令人担忧。
方法:从监测中确定接受POPRC或SRC的膀胱癌女性患者,流行病学,和结束结果(SEER)数据库。Logistic回归用于确定POPRC使用的预测因素。为了避免组间基线差异对生存率的潜在影响,a1:2倾向评分匹配(PSM)。之后,使用Kaplan-Meier曲线和Log-rank检验来确定SRC组和POPRC组患者之间总生存期(OS)差异的显著性。最后,基于预定指标进行亚组分析.
结果:共纳入2193例患者,中位随访时间为53个月,其中233人(10.6%)获得POPRC,1960人(89.4%)获得SRC。没有确定POPRC的明确预测因子。在PSM之前,POPRC产生了与SRC相当的OS(HR=1.09,p=0.309),而在PSM之后,POPRC与OS显著恶化相关(HR=1.23,p=0.038)。在亚组分析中,POPRC导致非肌层浸润性膀胱癌(NMIBC)和T2患者(HR=1.07,p=0.669)的非不良OS(HR=1.18,95CI0.71-1.95,p=0.531),但T3患者的OS显著恶化(HR=1.41,p=0.02)。
结论:目前,接受POPRC的患者没有经过严格的筛查,并且POPRC的候选人将来应该有更严格的标准,以获得令人满意的肿瘤结局.然而,研究中的缺陷使我们需要更多的证据来支持我们的发现。
BACKGROUND: Pelvic organ-preserving radical cystectomy (POPRC) has been reported to result in a better postoperative quality of life in female with bladder cancer compared to standard radical cystectomy (SRC). However, its oncological outcomes remain a concern.
METHODS: Female patients with bladder cancer who underwent POPRC or SRC were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression was used to identify predictors of POPRC usage. To avoid the potential impact of baseline differences between groups on survival, a 1:2 propensity score matching (PSM) was implemented. After that, Kaplan-Meier curves and Log-rank tests were used to determine the significance of overall survival (OS) differences between patients in the SRC group and POPRC group. Finally, subgroup analysis based on predetermined indicators was performed.
RESULTS: A total of 2193 patients were included with a median follow-up of 53 months, of whom 233 (10.6%) received POPRC and 1960 (89.4%) received SRC. No definitive predictors of POPRC were identified. Before PSM, POPRC resulted in comparable OS to SRC (HR = 1.09, p = 0.309), while after PSM, POPRC was associated with significantly worse OS (HR = 1.23, p = 0.038). In subgroup analyses, POPRC led to non-inferior OS (HR = 1.18, 95%CI 0.71-1.95, p = 0.531) in patients with non-muscle invasive bladder cancer (NMIBC) and T2 patients (HR = 1.07, p = 0.669), but significantly worse OS in T3 patients (HR = 1.41, p = 0.02).
CONCLUSIONS: Currently, patients undergoing POPRC have not undergone strict screening, and candidates for POPRC should have more stringent criteria in the future to achieve satisfactory oncological outcomes. However, flaws in the study make more evidence needed to support our findings.