Differential Analysis of Surgical Treatment Modalities in T2N0M0 Bladder Cancer Patients: A Novel Propensity Score-Based Cohort Study

Abstract

ObjectiveThis study explored prognostic differences between radical cystectomy (RC), tri-modality treatment (TURBt combined with radiotherapy and chemotherapy, TMT) and electrocautery (EC) and partial cystectomy (PC) for T2N0M0 MIBC. Materials and MethodsIn the SEER database (2004-2015, 2018-2020), we identified patients with T2N0M0 bladder cancer receiving RC, TMT, EC or PC treatment. To minimize confounding factors, 1:1 propensity score matching (PSM) with a 0.1 caliper was conducted. Kaplan-Meier analysis and log-rank tests were used to compare survival rates. Cox analysis identified independent prognostic factors, tumor size, and age, stratified treatment groups, and further Kaplan-Meier analysis of CSS was performed in matched cohorts. ResultThis study included 6526 patients with T2N0M0 MIBC. Among them, 348 (5.33%) were in the PC group, 309 (4.73%) were in the EC group, 1833 (28.09%) were in the TMT group, and 4036 (61.84%) were in the RC group. After 1:1 propensity score matching, RC showed improved CSS (HR=0.67, 95%CI 0.47-0.95, and PC also benefited (HR=0.97, 95%CI 0.69-1.36) compared to EC. While TMT showed a worse end (HR=1.41, 95%Cl 1.03-1.92) compared to EC. Cox analysis was used to stratify tumor size and age for subgroup analysis. Results for tumor size subgroups were aligned with PSM findings. In the age-stratified subgroups, patients aged <67 years, both RC (HR=0.54, P=0.107) and TMT(HR=0.91, P=0.785) showed better prognoses compared to EC treatment, while PC treatment showed worse prognoses compared to EC treatment (HR=1.23, P=0.542).; for 68-77 years, RC (0.64, P=0.1436) and PC (HR=0.46, P=0.0283)had advantages, and PC is more recommended. For >78 years, RC had superior CSS over EC and PC, whereas TMT had the poorest prognosis. ConclusionIn clinical T2N0M0 MIBC, overall, RC outperformed focal-tumor therapy and PC, irrespective of tumor size. However, considering age, we recommend PC treatment for patients aged 68-77 and EC for those aged >78 years. Micro-AbstractThis study compared radical cystectomy (RC), focal-tumor therapy combined with radiotherapy and chemotherapy (TMT and EC), and partial cystectomy (PC) for non-metastatic muscle-invasive bladder cancer. Using SEER data and a series of statistical analyses, overall, RC outperformed focal-tumor therapy and PC, irrespective of tumor size. However, considering age, we recommend PC treatment for patients aged 68-77 and EC for those aged >78 years. In contrast, for patients younger than 67 years of age, we recommend RC for those who can tolerate surgical treatment and TMT for those who can't.