{"title":"Association between tumor size and prognosis in bladder cancer: novel classifications and insights from a SEER database analysis.","authors":"Yige Jia, Kan Wu, Xiang Li","doi":"10.3389/fsurg.2024.1489832","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Although tumor size is an essential oncologic feature, it is often underutilized in diagnosing and treating bladder cancer (BC). This study investigates the relationship between tumor size and BC prognosis, aiming to enhance clinical applications.</p><p><strong>Methods: </strong>BC patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015). Cox proportional hazard models were conducted to identify prognostic factors, and restricted cubic splines (RCS) were used to assess the relationship between tumor size and survival outcomes. The Kaplan-Meier method and multivariate COX models were utilized to estimate the effect of the classification scheme.</p><p><strong>Results: </strong>A total of 69,478 patients with BC were evaluated from the SEER database. Larger tumor size, recent diagnosis, older age, high pathologic grade, variant histology, advanced T stages, positive lymph node status, and receipt of radiotherapy and chemotherapy were associated with worse overall and cancer-specific survival. RCS curves of each stage showed that the relationship between tumor size and prognosis was non-linear. Optimal cut-off points were identified based on the shape of RCS curves, suggesting new classifications of tumor size: 2.5 cm and 5 cm for Ta, 3 cm and 5 cm for T1, and 4 cm and 6 cm for T2.</p><p><strong>Conclusions: </strong>Incorporating tumor size into prognostic evaluations can enhance bladder cancer risk stratification. Further research is needed to validate these findings and improve personalized treatment strategies.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"11 ","pages":"1489832"},"PeriodicalIF":1.6000,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11625752/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fsurg.2024.1489832","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Although tumor size is an essential oncologic feature, it is often underutilized in diagnosing and treating bladder cancer (BC). This study investigates the relationship between tumor size and BC prognosis, aiming to enhance clinical applications.
Methods: BC patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015). Cox proportional hazard models were conducted to identify prognostic factors, and restricted cubic splines (RCS) were used to assess the relationship between tumor size and survival outcomes. The Kaplan-Meier method and multivariate COX models were utilized to estimate the effect of the classification scheme.
Results: A total of 69,478 patients with BC were evaluated from the SEER database. Larger tumor size, recent diagnosis, older age, high pathologic grade, variant histology, advanced T stages, positive lymph node status, and receipt of radiotherapy and chemotherapy were associated with worse overall and cancer-specific survival. RCS curves of each stage showed that the relationship between tumor size and prognosis was non-linear. Optimal cut-off points were identified based on the shape of RCS curves, suggesting new classifications of tumor size: 2.5 cm and 5 cm for Ta, 3 cm and 5 cm for T1, and 4 cm and 6 cm for T2.
Conclusions: Incorporating tumor size into prognostic evaluations can enhance bladder cancer risk stratification. Further research is needed to validate these findings and improve personalized treatment strategies.
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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