手术方式对T_(2a)N_(0)M_(0)肌层浸润性膀胱移行细胞癌患者生存率的影响

The effect of surgical approach on the survival outcomes of patients with T_(2a)N_(0)M_(0)stage muscle-invasive bladder transitional cell carcinoma

目的探讨经尿道膀胱肿瘤切除术(TURBT)与根治性膀胱切除术(RC)对T_(2a)N_(0)M_(0)肌层浸润性膀胱移行细胞癌(BTCC)患者生存率影响。方法通过SEER*Stat软件,从美国国立癌症研究所(SEER)数据库中获取了2010至2015年诊断为T_(2a)N_(0)M_(0)肌层浸润性BTCC患者的临床及预后资料。根据患者接受的手术类型进行分组(TURBT或RC),并采用1∶1倾向性得分匹配(PSM)法来平衡两组患者基线资料的差异。采用Kaplan-Meier法绘制生存曲线,并采用Log-rank检验比较两组患者总体生存率(OS)和癌症特异性生存率(CSS)。采用单因素及多因素Cox回归分析,评估了患者CSS的独立危险因素。结果纳入1032例患者资料,匹配后,TURBT组和RC组各有270例患者资料。Log-rank检验结果显示,TURBT组与RC组患者的OS、CSS差异均具有统计学意义(P<0.01),且RC组患者OS和CSS均更高。多因素Cox回归结果显示,手术方式选择TURBT、患者年龄超过60岁、未婚状态以及肿瘤直径大于5.0 cm都是影响T_(2a)N_(0)M_(0)肌层浸润性膀胱移行细胞癌患者CSS的独立危险因素。选择RC作为手术方式是患者预后的保护性因素(HR=0.387,95%CI:0.282~0.532,P<0.001)。结论对于T_(2a)N_(0)M_(0)肌层浸润性膀胱癌患者,根治性膀胱切除术能带来更高生存率,是一种更为有效的治疗选择。

Objective To assess the impact of transurethral resection of bladder tumor(TURBT)and radical cystectomy(RC)on the survival outcomes of patients with T_(2a)N_(0)M_(0)stage muscle-invasive bladder transitional cell carcinoma(BTCC).Methods The clinical and prognostic data of patients diagnosed with T_(2a)N_(0)M_(0)muscle-invasive BTCC from 2010 to 2015 were extracted from the SEER database using SEER*Stat software.A 1∶1 propensity score matching(PSM)method was employed to balance the baseline data discrepancies between the TURBT and RC groups.Kaplan-Meier methods was used to plot survival curves,and overall survival(OS)and cancer-specific survival(CSS)were compared using the log-rank test.Univariate and multivariate Cox regression were conducted to identify the independent risk factors of CSS.Results A total of 1032 patients diagnosed with T_(2a)N_(0)M_(0)BTCC were included in this study.There were 270 patient records in both the TURBT group and the RC group,following 1∶1 PSM.The log-rank test indicated that there was a significant difference in both OS and CSS between the RC and TURBT groups(P<0.001),with the RC group demonstrating a superior prognosis.The results of the multivariate Cox regression analysis revealed that TURBT,age over 60 years,unmarried status and tumor diameter exceeding 5.0 cm were independent risk factor for CSS in patients with T_(2a)N_(0)M_(0)muscle-invasive BTCC,in contrast,RC was identified as a protective factor of prognosis(HR=0.387,95%CI:0.282~0.532,P<0.001).Conclusion RC is associated with improved CSS in patients with T_(2a)N_(0)M_(0)muscle-invasive BTCC,which is a more effective treatment option.