Jacob Schmidt, Kira Furlano, Patricia Kellmer, Hans Krause, Tobias Klatte, Kurt Miller, Thorsten Schlomm, Sebastian L Hofbauer
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Statistical analysis was performed using Cox regression and Kaplan-Meier method to determine survival rates and risk factors.</p><p><strong>Results: </strong>The cohort consisted of 58 patients with MIBC with a median age of 71 years. The 5-year overall survival (OS), cancer specific survival (CSS) and recurrence-free survival (RFS) rates were 55%, 67% and 51%, respectively. Clinical suspicion for lymph node metastases (HR 3.82, CI 1.09-13.39, P = 0.036), advanced T-stages (HR 3.80, CI 1.38-10.49, P = 0.010), a higher grading (HR 6.57, CI 0.76-49.19, P = 0.010), positive resection margins (HR 1.81, CI 1.10-2.96, P = 0.012), lymphovascular invasion (HR 5.14, CI 1.77-14.88, P = 0.003), vascular invasion (HR 6.62, CI 2.16-20.27, P = 0. 001), and longer time from initial diagnosis to surgery (HR 1.003, CI 1.001-1.01, days, P = 0.010) were associated with decreased OS. Complications within the first 30 and 90 postoperative days were observed in 31% and 36% of patients, respectively. 4% experienced a Clavien-Dino grade III/IV complication. One patient developed acute respiratory distress syndrome and died 46 days after surgery.</p><p><strong>Conclusion: </strong>Partial cystectomy appears to be a safe bladder-sparing approach for highly selected MIBC patients with favorable oncologic outcomes and acceptable complication rates. Patient selection and assessment of tumor characteristics are essential for successful outcomes. Prospective randomized controlled trials are needed.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Retrospective analysis of partial cystectomy in patients with muscle-invasive urothelial carcinoma: A German single-center experience.\",\"authors\":\"Jacob Schmidt, Kira Furlano, Patricia Kellmer, Hans Krause, Tobias Klatte, Kurt Miller, Thorsten Schlomm, Sebastian L Hofbauer\",\"doi\":\"10.1016/j.urolonc.2024.11.021\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Partial cystectomy (PC) has been proposed as a less invasive alternative to radical cystectomy (RC) for the treatment of localized muscle-invasive bladder cancer (MIBC). The aim of this study was to evaluate the outcome of PC in a contemporary patient cohort to identify potential risk factors for this procedure.</p><p><strong>Methods: </strong>Data from 58 MIBC patients who underwent PC were retrospectively analyzed. Demographics, tumor characteristics, clinical outcomes, and pathology results were collected. Statistical analysis was performed using Cox regression and Kaplan-Meier method to determine survival rates and risk factors.</p><p><strong>Results: </strong>The cohort consisted of 58 patients with MIBC with a median age of 71 years. The 5-year overall survival (OS), cancer specific survival (CSS) and recurrence-free survival (RFS) rates were 55%, 67% and 51%, respectively. Clinical suspicion for lymph node metastases (HR 3.82, CI 1.09-13.39, P = 0.036), advanced T-stages (HR 3.80, CI 1.38-10.49, P = 0.010), a higher grading (HR 6.57, CI 0.76-49.19, P = 0.010), positive resection margins (HR 1.81, CI 1.10-2.96, P = 0.012), lymphovascular invasion (HR 5.14, CI 1.77-14.88, P = 0.003), vascular invasion (HR 6.62, CI 2.16-20.27, P = 0. 001), and longer time from initial diagnosis to surgery (HR 1.003, CI 1.001-1.01, days, P = 0.010) were associated with decreased OS. Complications within the first 30 and 90 postoperative days were observed in 31% and 36% of patients, respectively. 4% experienced a Clavien-Dino grade III/IV complication. One patient developed acute respiratory distress syndrome and died 46 days after surgery.</p><p><strong>Conclusion: </strong>Partial cystectomy appears to be a safe bladder-sparing approach for highly selected MIBC patients with favorable oncologic outcomes and acceptable complication rates. Patient selection and assessment of tumor characteristics are essential for successful outcomes. Prospective randomized controlled trials are needed.</p>\",\"PeriodicalId\":23408,\"journal\":{\"name\":\"Urologic Oncology-seminars and Original Investigations\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-12-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Urologic Oncology-seminars and Original Investigations\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.urolonc.2024.11.021\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urologic Oncology-seminars and Original Investigations","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.urolonc.2024.11.021","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：部分膀胱切除术（PC）被认为是治疗局限性肌浸润性膀胱癌（MIBC）的一种侵入性更小的方法，可以替代根治性膀胱切除术（RC）。本研究的目的是评估当代患者队列中PC的结果，以确定该手术的潜在危险因素。方法：回顾性分析58例MIBC患者行PC术的资料。收集人口统计学、肿瘤特征、临床结局和病理结果。采用Cox回归和Kaplan-Meier法进行统计学分析，确定生存率和危险因素。结果：该队列包括58例MIBC患者，中位年龄为71岁。5年总生存率（OS）为55%，肿瘤特异性生存率（CSS）为67%，无复发生存率（RFS）为51%。临床怀疑淋巴结转移（HR 3.82, CI 1.09 ~ 13.39, P = 0.036）、晚期t分期（HR 3.80, CI 1.38 ~ 10.49, P = 0.010）、较高分级（HR 6.57, CI 0.76 ~ 49.19, P = 0.010）、切缘阳性（HR 1.81, CI 1.10 ~ 2.96, P = 0.012）、淋巴血管侵犯（HR 5.14, CI 1.77 ~ 14.88, P = 0.003）、血管侵犯（HR 6.62, CI 2.16 ~ 20.27, P = 0.03）。从最初诊断到手术时间较长（HR 1.003, CI 1.001-1.01，天，P = 0.010）与OS降低相关。31%和36%的患者在术后30天和90天内出现并发症。4%出现Clavien-Dino III/IV级并发症。一名患者出现急性呼吸窘迫综合征，术后46天死亡。结论：部分膀胱切除术似乎是一种安全的保膀胱方法，对于高度选择性的MIBC患者具有良好的肿瘤预后和可接受的并发症发生率。患者的选择和肿瘤特征的评估是必不可少的成功的结果。需要前瞻性随机对照试验。
Retrospective analysis of partial cystectomy in patients with muscle-invasive urothelial carcinoma: A German single-center experience.
Objectives: Partial cystectomy (PC) has been proposed as a less invasive alternative to radical cystectomy (RC) for the treatment of localized muscle-invasive bladder cancer (MIBC). The aim of this study was to evaluate the outcome of PC in a contemporary patient cohort to identify potential risk factors for this procedure.
Methods: Data from 58 MIBC patients who underwent PC were retrospectively analyzed. Demographics, tumor characteristics, clinical outcomes, and pathology results were collected. Statistical analysis was performed using Cox regression and Kaplan-Meier method to determine survival rates and risk factors.
Results: The cohort consisted of 58 patients with MIBC with a median age of 71 years. The 5-year overall survival (OS), cancer specific survival (CSS) and recurrence-free survival (RFS) rates were 55%, 67% and 51%, respectively. Clinical suspicion for lymph node metastases (HR 3.82, CI 1.09-13.39, P = 0.036), advanced T-stages (HR 3.80, CI 1.38-10.49, P = 0.010), a higher grading (HR 6.57, CI 0.76-49.19, P = 0.010), positive resection margins (HR 1.81, CI 1.10-2.96, P = 0.012), lymphovascular invasion (HR 5.14, CI 1.77-14.88, P = 0.003), vascular invasion (HR 6.62, CI 2.16-20.27, P = 0. 001), and longer time from initial diagnosis to surgery (HR 1.003, CI 1.001-1.01, days, P = 0.010) were associated with decreased OS. Complications within the first 30 and 90 postoperative days were observed in 31% and 36% of patients, respectively. 4% experienced a Clavien-Dino grade III/IV complication. One patient developed acute respiratory distress syndrome and died 46 days after surgery.
Conclusion: Partial cystectomy appears to be a safe bladder-sparing approach for highly selected MIBC patients with favorable oncologic outcomes and acceptable complication rates. Patient selection and assessment of tumor characteristics are essential for successful outcomes. Prospective randomized controlled trials are needed.
期刊介绍：
Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.
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