Background: It is unknown whether more complex UD, such as orthotopic neobladder and abdominal pouch, may be associated with higher OCM rates than ileal conduit. We addressed this knowledge gap within the SEER database 2004–2020. Methods: All T1-T4aN0M0radical cystectomy (RC) patients were identified. After 1:1 propensity score matching (PSM), cumulative incidence plots, univariable and multivariable competing-risks regression (CRR) models were used to test differences in OCM rates according to UD type (orthotopic neobladder vs. abdominal pouch vs. ileal conduit). Results: Of all 3008 RC patients, 2380 (79%) underwent ileal conduit vs. 628 (21%) who underwent continent UD (268 orthotopic neobladder and 360 abdominal pouch). After PSM relative to ileal conduit, neither continent UD (13 vs. 15%;p= 0.1) nor orthotopic neobladder (13 vs. 16%;p= 0.4) nor abdominal pouch (13 vs. 15%;p= 0.2) were associated with higher 10-year OCM rates. After PSM and after adjustment for cancer-specific mortality (CSM), as well as after multivariable adjustments relative to ileal conduit, neither continent UD (Hazard Ratio [HR]:0.73;p= 0.1), nor orthotopic neobladder (HR:0.84;p= 0.5) nor abdominal pouch (HR:0.77;p= 0.2) were associated with higher OCM. Conclusions: It appears that more complex UD types, such as orthotopic neobladder and abdominal pouch are not associated with higher OCM relative to ileal conduit.
背景：目前尚不清楚更复杂的尿流改道术（UD），如原位新膀胱术和腹壁储尿囊术，是否比回肠通道术具有更高的其他原因死亡率（OCM）。我们利用2004-2020年SEER数据库中的数据来填补这一知识空白。方法：识别所有T1-T4aN0M0期接受根治性膀胱切除术（RC）的患者。经过1:1倾向评分匹配（PSM）后，采用累积发生率曲线、单变量及多变量竞争风险回归（CRR）模型，根据UD类型（原位新膀胱术 vs. 腹壁储尿囊术 vs. 回肠通道术）检验OCM率的差异。结果：在所有3008例RC患者中，2380例（79%）接受了回肠通道术，628例（21%）接受了可控性UD（其中268例为原位新膀胱术，360例为腹壁储尿囊术）。经过PSM后，与回肠通道术相比，无论是可控性UD（13% vs. 15%；p=0.1）、原位新膀胱术（13% vs. 16%；p=0.4）还是腹壁储尿囊术（13% vs. 15%；p=0.2），其10年OCM率均未显著升高。在PSM后并调整癌症特异性死亡率（CSM）以及进行多变量调整后，与回肠通道术相比，可控性UD（风险比[HR]:0.73；p=0.1）、原位新膀胱术（HR:0.84；p=0.5）和腹壁储尿囊术（HR:0.77；p=0.2）均未显示出更高的OCM风险。结论：相对于回肠通道术，更复杂的UD类型（如原位新膀胱术和腹壁储尿囊术）似乎并未与更高的OCM相关。
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