Clinical genitourinary cancer · 2026
The Contemporary Pattern of Radical Cystectomy in the Treatment of High-Grade Non-Muscle Invasive Bladder Cancer.
СтатьяНазвание и аннотация: Перевод в очереди
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Iranmahboub Parsa, Dave Priya, Levine Joshua, Wang Shu, Xu Helen, Blum Kyle A, Angulo-Lozano Juan C, Wahba Brandon Malik, Suzman Evan, Scherr Douglas S
Аннотация
INTRODUCTION: Radical cystectomy (RC) remains the most effective treatment for high-grade non-muscle invasive bladder cancer (HG NMIBC) with high-risk features or after failed bladder preservation. Yet, utilization varies and understanding contemporary treatment patterns can help guide personalized care, especially amid expanding bladder-sparing options. This study assessed national trends and outcomes in HG NMIBC management with RC from 2010 to 2022.
PATIENTS AND METHODS: The National Cancer Database (NCDB) was queried for clinically localized HG NMIBC. Determinants of RC use, time to RC, pathologic upstaging, and all-cause mortality were analyzed using multivariable linear, logistic, or Cox proportional hazards models. As a covariate, RC timing used 90- and 180-day cutoffs.
RESULTS: Across 220,672 HG NMIBC patients, RC use has declined since 2010. Black race had lower odds of RC use (odds ratios [OR] 0.89, P < .01), whereas variant histology (OR 4.88, P < .01) and treatment at academic centers (OR 3.47, P < .01) predicted higher odds. Among 9360 patients who underwent RC, time to surgery has increased. A total of 42% of RC patients had advanced upstaging, which was associated with RC performed 180 days after diagnosis (OR 1.2, P = .018), female sex (OR 1.14, P = .012), Black race (OR 1.2, P = .047), and variant histology (OR 1.94, P < .01). Treatment at academic centers (OR 0.73, P < .01) had lower upstaging risk. Improved all-cause mortality was linked to academic centers (hazard ratios 0.87, P < .01), with no significant difference by RC timing beyond 90 or 180 days (P > .05).
CONCLUSION: RC use for HG NMIBC has declined, while time to RC has increased. Longer time to RC was not uniformly associated with greater upstaging or all-cause mortality among RC patients. These findings highlight evolving practice patterns and need for long-term studies to optimize timing and integration of RC among emerging therapies. Limitations include lack of NCDB granularity to compare intentionally early versus deferred RC.
PATIENTS AND METHODS: The National Cancer Database (NCDB) was queried for clinically localized HG NMIBC. Determinants of RC use, time to RC, pathologic upstaging, and all-cause mortality were analyzed using multivariable linear, logistic, or Cox proportional hazards models. As a covariate, RC timing used 90- and 180-day cutoffs.
RESULTS: Across 220,672 HG NMIBC patients, RC use has declined since 2010. Black race had lower odds of RC use (odds ratios [OR] 0.89, P < .01), whereas variant histology (OR 4.88, P < .01) and treatment at academic centers (OR 3.47, P < .01) predicted higher odds. Among 9360 patients who underwent RC, time to surgery has increased. A total of 42% of RC patients had advanced upstaging, which was associated with RC performed 180 days after diagnosis (OR 1.2, P = .018), female sex (OR 1.14, P = .012), Black race (OR 1.2, P = .047), and variant histology (OR 1.94, P < .01). Treatment at academic centers (OR 0.73, P < .01) had lower upstaging risk. Improved all-cause mortality was linked to academic centers (hazard ratios 0.87, P < .01), with no significant difference by RC timing beyond 90 or 180 days (P > .05).
CONCLUSION: RC use for HG NMIBC has declined, while time to RC has increased. Longer time to RC was not uniformly associated with greater upstaging or all-cause mortality among RC patients. These findings highlight evolving practice patterns and need for long-term studies to optimize timing and integration of RC among emerging therapies. Limitations include lack of NCDB granularity to compare intentionally early versus deferred RC.