Background: Pelvic lymph node dissection during standard radical cystectomy (stdRC) for muscle invasive bladder cancer is performed as separate templates. In the modernized en bloc radical cystectomy (mEbRC), the bladder is removed together with all its associated lymphatic tissue as one specimen. Our aim was to evaluate the oncological and surgical outcomes of mEbRC with a propensity-matched national cohort of stdRC cases.Methods: 935 patients (mEbRC: 214 and stdRC: 721) were eligible for analysis, and 1:2 propensity score matching was performed regressing mEbRC treatment on the variables age, gender, neoadjuvant chemotherapy, Charlson Comorbidity Index, lymph node metastases at final pathology, carcinoma in situ, and pT-stage. The primary outcome was recurrence-free survival (RFS). Secondary endpoints were overall survival (OS) and cancer-specific survival (CSS), survival for female patients. and perioperative measures.Results: There were no significant differences between the groups regarding complications, 30-day readmission rates, and 30- and 90-day mortality rates. In the propensity score matched groups, the 5-year RFS was 83% in the mEbRC group vs. 67% in the stdRC group (p< 0.001), the CSS was 89% and 78% (p≤ 0.001), and OS 81% vs. 68% (p< 0.001) in the same groups, respectively. The results were confirmed by Cox regression analyses with hazard ratios ranging from 0.41 to 0.50 andp-values ≤ 0.001, favoring mEbRC. The 5-year OS for female patients was 86% for mEbRC and 60% for stdRC (p= 0.022).Conclusions: Performing mEbRC over stdRC might yield significantly better oncological outcomes, with equal survival rates for both genders.
背景：在针对肌层浸润性膀胱癌的标准根治性膀胱切除术（stdRC）中，盆腔淋巴结清扫通常作为独立模板进行。而在现代化的整块根治性膀胱切除术（mEbRC）中，膀胱及其所有相关淋巴组织被作为一个整体标本切除。本研究旨在通过倾向性匹配的全国性stdRC病例队列，评估mEbRC的肿瘤学及手术效果。 方法：共935例患者（mEbRC组214例，stdRC组721例）符合分析条件。以年龄、性别、新辅助化疗、查尔森合并症指数、最终病理淋巴结转移状态、原位癌及pT分期为变量，对mEbRC治疗组进行1:2倾向评分匹配。主要研究终点为无复发生存期（RFS），次要终点包括总生存期（OS）、癌症特异性生存期（CSS）、女性患者生存率及围手术期指标。 结果：两组在并发症发生率、30天再入院率、30天及90天死亡率方面均无显著差异。在倾向评分匹配组中，mEbRC组的5年RFS为83%，显著高于stdRC组的67%（p<0.001）；CSS分别为89%和78%（p≤0.001）；OS分别为81%和68%（p<0.001）。Cox回归分析进一步证实了上述结果，风险比范围为0.41至0.50（p值均≤0.001），支持mEbRC的疗效优势。女性患者5年OS在mEbRC组为86%，显著高于stdRC组的60%（p=0.022）。 结论：与stdRC相比，实施mEbRC可能获得显著更优的肿瘤学结局，且两性生存率相当。
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