在急性囊切除过程中并发性尿切除术的瘤结局:从韩国多中心数据库进行多变量调整的倾向性得分匹配分析
Sang Hun Song1, Jong Ho Park2, Sangchul Lee1
1Department of Urology, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.
Surgical oncology
|February 10, 2026
概括
在膀癌的激进囊切除术 (RCx) 期间同时进行脏切除术 (RNU) 会增加复发率,但不会影响存活率. 这种手术对于需要密切监测的选定患者来说是瘤安全的.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 在瘤学瘤学.
- 手术瘤学手术瘤学
背景情况:
- 由于潜在的患者选择偏见,结合激进脏切除术 (RNU) 与膀癌的激进囊切除术 (RCx) 的瘤安全性受到争议.
- 之前的研究缺乏可靠的数据来最终评估这种联合程序的风险和益处.
研究的目的:
- 评估RCx.期间并发RNU的瘤结果.
- 通过倾向分数匹配 (PSM) 尽量减少选择偏差,并确定膀癌患者的独立预后因素.
主要方法:
- 从韩国多中心数据库 (2000-2022) 分析了接受RCx的2944名患者.
- 分层为只有RCx和并发的RCx + RNU组.
- 倾向分数匹配 (PSM) 创建了284个匹配的对.
- 对关键变量进行调整的多变量考克斯回归分析.
主要成果:
- 同时的RCx + RNU显示复发率显著更高 (60.4%vs 40.9%),但在5年癌症特异性存活率 (CSS) 或整体存活率 (OS) 上没有显著差异.
- 多变量分析表明并发的RNU不是RFS,CSS或OS的独立预后因素.
- 病理性N+疾病,淋巴血管侵袭和高ASA得分是独立的不良预后因素.
结论:
- 在RCx期间并发的RNU与更高的复发率有关,但不会影响CSS或OS.
- 增加的复发可能反映出更具侵略性的疾病生物学,而不是不良的外科手术效应.
- 一阶段并发RNU在选定的患者中是瘤安全的,需要密集监测.
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