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

F.A. Mistretta, S.-J. Cyr, S. Luzzago, E. Mazzone, S. Knipper, C. Palumbo, Z. Tian, S. Nazzani, F. Saad, E. Montanari, D. Tilki, A. Briganti, S.F. Shariat, O. de Cobelli, P.I. Karakiewicz

Research output: Contribution to journalArticlepeer-review

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. © 2019 Elsevier Inc. Using data from 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 partial cystectomy (PC) or radical cystectomy (RC) were evaluated. No statistically significant differences in cancer-specific or other-cause mortality between the PC and RC groups was identified. Within the PC group, pelvic lymph node dissection had been omitted 50% of the time despite its association with lower cancer-specific mortality rates. © 2019 Elsevier Inc.
Original languageEnglish
Pages (from-to)129-137.e3
JournalClin. Genitourin. Cancer
Volume18
Issue number2
DOIs
Publication statusPublished - 2020

Keywords

  • Cystectomy
  • Lymph node excision
  • Mortality
  • SEER program
  • Urinary bladder neoplasms
  • adult
  • aged
  • Article
  • bladder carcinoma
  • cancer mortality
  • cancer patient
  • cancer prognosis
  • cancer registry
  • cancer specific mortality
  • cancer staging
  • cancer survival
  • clinical outcome
  • cohort analysis
  • cystectomy
  • female
  • human
  • intermethod comparison
  • major clinical study
  • male
  • mortality
  • other cause mortality
  • pelvis lymphadenectomy
  • propensity score
  • retrospective study
  • transitional cell carcinoma
  • trend study

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