Partial Cystectomy With Pelvic Lymph Node Dissection for Patients With Nonmetastatic Stage pT2-T3 Urothelial Carcinoma of Urinary Bladder: Temporal Trends and Survival Outcomes.

Abstract

INTRODUCTION:

We investigated the effect of partial cystectomy (PC) on cancer-specific mortality (CSM) and other-cause mortality (OCM) and the effect of pelvic lymph node dissection (PLND) during PC on CSM.

MATERIALS AND METHODS:

Within the Surveillance, Epidemiology, and End Results database (2004-2015), 11,429 cases of nonmetastatic stage pT2-T3 urothelial carcinoma of the urinary bladder treated with either PC or radical cystectomy (RC) were identified. All comparisons between PC and RC relied on propensity score (PS; ratio, 1:1) adjusted univariable and multivariable logistic and competing risks regression models. In contrast, all comparisons between PLND and no PLND at PC relied on inverse probability of treatment weighting-adjusted univariable and multivariable Cox regression models.

RESULTS:

Within the SEER database, PC had been performed in 979 patients (8.6%). The PC annual rates decreased from 11.0% to 6.8% during the study period (P < .001). In PS-adjusted multivariable analyses focusing on CSM and OCM, no statistically significant difference between the PC and RC groups (P = .2 and P = .3, respectively). The annual PLND rates with PC (50.3%) did not vary over time (P = .3). In the overall cohort and the PC subgroup, PLND was associated with a lower CSM rate (hazard ratio, 0.56; P < .001; and hazard ratio, 0.57; P < .001, respectively).

CONCLUSIONS:

A small proportion of patients with stage pT2-T3 urothelial carcinoma of the urinary bladder were candidates for PC. In the PS-adjusted multivariable analyses, no statistically significant differences were found in CSM or OCM between the PC and RC groups. Within the PC group, PLND had been omitted 50% of the time despite its association with lower CSM.

• Authors: Francesco A Mistretta, Sarah-Jeanne Cyr, Stefano Luzzago, Elio Mazzone, Sophie Knipper, Carlotta Palumbo, Zhe Tian, Sebastiano Nazzani, Fred Saad, Emanuele Montanari, Derya Tilki, Alberto Briganti, Shahrokh F Shariat, Ottavio de Cobelli, Pierre I Karakiewicz
• Journal: Clinical genitourinary cancer (Clin Genitourin Cancer) Vol. 18 Issue 2 Pg. 129-137.e3 (04 2020) ISSN: 1938-0682 [Electronic] United States
• PMID: 32001182 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Carcinoma, Transitional Cell (mortality, pathology, surgery)
• Cystectomy (methods, statistics & numerical data, trends)
• Female
• Humans
• Kaplan-Meier Estimate
• Lymph Node Excision (statistics & numerical data, trends)
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Staging
• Retrospective Studies
• SEER Program (statistics & numerical data)
• Treatment Outcome
• Urinary Bladder (pathology, surgery)
• Urinary Bladder Neoplasms (mortality, pathology, surgery)