目的:评估无事件生存期对非转移性膀胱肌肉浸润性鳞状细胞癌根治性膀胱切除术(RC)后癌症特异性死亡率(CSM)的影响。
方法:在监测范围内确定接受非转移性肌肉浸润性膀胱鳞状细胞癌治疗的RC患者,流行病学,和最终结果数据库(2000-2018年)。T和N阶段分组的CSM的独立预测因子状态(即,T2N0,T3N0,T4N0和TanyN1-3)在多变量Cox回归模型中进行了测试。在基线和4个特定的无事件生存时间(即6、12、18和24个月)评估了有条件的5年无CSM估计值,在4个检查阶段组中的每一个中。
结果:在981例RC患者中,206(21%),416(42%),152(16%),和207(21%)分别为T2N0,T3N0,T4N0和TanyN1-3。在多变量Cox回归模型T3N0(HR1.94)中,T4N0(HR5.22),TanyN1-3(HR6.62)是CSM的独立预测因子,相对于T2N0。在基于24个月无事件状态的条件生存分析中,生存率估计为:T2N0的89%与基线为76%(Δ=13%),T3N0的84%与基线时58%(Δ=26%),T4N0的69%与基线时25%(Δ=44%),69%的TanyN1-3与基线为22%(Δ=47%)。
结论:随访24个月时的无事件状态与无CSM生存率显著高于基线时的无CSM生存率。这种效应的幅度在TanyN1-3和T4N0患者中最为明显,在T3N0中间,更温和,尽管如此,重要的是,在T2N0。
To assess the effect of event-free survival duration on cancer-specific mortality (CSM) after radical cystectomy (RC) in nonmetastatic muscle-invasive squamous cell carcinoma of the urinary bladder.
RC patients treated for non-metastatic muscle-invasive squamous cell carcinoma of the urinary bladder were identified within the Surveillance, Epidemiology, and End Results database (2000-2018). Independent predictor status for CSM of T and N stage groupings (i.e., T2N0, T3N0, T4N0, and TanyN1-3) was tested in multivariable Cox-regression models. Conditional 5-year CSM-free estimates were assessed at baseline and at 4 specific event-free survival times (i.e. 6, 12, 18 and 24 months), within each of the 4 examined stage groups.
Of 981 RC patients, 206 (21%), 416 (42%), 152 (16%), and 207 (21%) were T2N0, T3N0, T4N0, and TanyN1-3, respectively. In multivariable Cox-regression models T3N0 (HR 1.94), T4N0 (HR 5.22), and TanyN1-3 (HR 6.62) were independent predictors of CSM, relative to T2N0. In conditional survival analyses based on 24 months event-free status, survival estimates were: 89% for T2N0 vs. 76% at baseline (Δ = 13%), 84% for T3N0 vs. 58% at baseline (Δ = 26%), 69% for T4N0 vs. 25% at baseline (Δ = 44%), 69% for TanyN1-3 vs. 22% at baseline (Δ = 47%).
Event-free status at 24 months of follow-up is associated with substantially higher CSM-free survival than when CSM-free survival is predicted at baseline. The magnitude of this effect is most pronounced in TanyN1-3 and T4N0 patients, intermediate in T3N0 and more modest, nonetheless important, in T2N0.