Background: Trimodal therapy is considered the most validated bladder-sparing treatment in patients with organ-confined urothelial carcinoma of the urinary bladder (T2N0M0). However, scarce evidence exists regarding cancer-specific mortality (CSM) differences between trimodal therapy and other non-extirpative multimodal treatment options such as radiotherapy alone after transurethral resection (TURBT + RT) or chemotherapy alone after transurethral resection (TURBT + CT). Methods: Within the Surveillance, Epidemiology, and End Results database (2004–2020), we identified T2N0M0 patients treated with either trimodal therapy, TURBT + CT, or TURBT + RT. Temporal trends described trimodal therapy vs. TUBRT + CT vs. TURBT + RT use over time. Survival analyses consisting of Kaplan–Meier plots and multivariable Cox regression (MCR) models addressed CSM according to each treatment modality. Results: 3729 (40%) patients underwent TMT vs. 4030 (43%) TURBT + CT vs. 1599 (17%) TURBT + RT. Over time, trimodal therapy use (Estimating annual percent change, EAPC: +1.2%,p= 0.01) and TURBT + CT use increased (EAPC: +1.5%,p= 0.01). In MCR models, relative to trimodal therapy, TURBT + CT exhibited 1-14-fold higher CSM and TURBT + RT 1.68-fold higher CSM. In a subgroup analysis, TURBT + RT was associated with 1.42-fold higher CSM than TURBT + CT (p< 0.001). Conclusions: Strict trimodal therapy that includes both CT and RT after TURBT offers the best cancer control. When strict trimodal therapy cannot be delivered, cancer-specific survival outcomes appear to be superior with TURBT + chemotherapy compared to TURBT + RT.
背景：对于器官局限性膀胱尿路上皮癌（T2N0M0）患者，三联疗法被视为最有效的保膀胱治疗方案。然而，关于三联疗法与其他非根治性多模式治疗方案（如经尿道膀胱肿瘤电切术后单纯放疗或经尿道膀胱肿瘤电切术后单纯化疗）在癌症特异性死亡率方面的差异，现有证据尚不充分。方法：基于美国监测、流行病学和最终结果数据库（2004-2020年），我们筛选出接受三联疗法、经尿道膀胱肿瘤电切术联合化疗或经尿道膀胱肿瘤电切术联合放疗的T2N0M0期患者。通过时间趋势分析描述三种治疗方式随时间推移的应用变化。采用Kaplan-Meier曲线和多变量Cox回归模型进行生存分析，评估不同治疗模式下的癌症特异性死亡率。结果：3729例（40%）患者接受三联疗法，4030例（43%）接受经尿道膀胱肿瘤电切术联合化疗，1599例（17%）接受经尿道膀胱肿瘤电切术联合放疗。随时间推移，三联疗法（估计年度百分比变化值：+1.2%，p=0.01）和经尿道膀胱肿瘤电切术联合化疗（估计年度百分比变化值：+1.5%，p=0.01）的应用均呈上升趋势。多变量Cox回归模型显示，与三联疗法相比，经尿道膀胱肿瘤电切术联合化疗的癌症特异性死亡率风险增加1.14倍，经尿道膀胱肿瘤电切术联合放疗则增加1.68倍。亚组分析表明，经尿道膀胱肿瘤电切术联合放疗的癌症特异性死亡率风险较经尿道膀胱肿瘤电切术联合化疗增加1.42倍（p<0.001）。结论：包含经尿道膀胱肿瘤电切术后联合放化疗的严格三联疗法能提供最佳的肿瘤控制效果。当无法实施严格三联疗法时，经尿道膀胱肿瘤电切术联合化疗的癌症特异性生存结局优于经尿道膀胱肿瘤电切术联合放疗。
肿瘤(癌症)患者之家