European journal of medical research · 2025
The impact of surgery and survival prediction in patients with bladder neuroendocrine carcinoma: a novel propensity score-matched population-based cohort study.
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Liu Jianyong, Lai Shicong, Lu Na, Luo Shuhang, Tang Runhua, Li Lin, Wu Pengjie, Wang Dongwen, Tian Jun
Аннотация
OBJECTIVE: To evaluate the effects of surgical interventions on individuals diagnosed with bladder neuroendocrine carcinoma (BNEC).
MATERIALS AND METHODS: Data were gathered from the Surveillance, Epidemiology, and End Results (SEER) database for this retrospective analysis. No-surgery procedures included TURBT, cryotherapy, excisional biopsy, or partial cystectomy. Surgery was categorized as cystectomy, radical cystectomy, or a more complex surgical intervention, such as exenteration. A propensity score overlap weight (PSOW) analysis was performed to adjust statistical influences between the two groups. Prognostic factors related to cancer-specific survival (CSS) and overall survival (OS) were assessed using Cox proportional hazard regression.
RESULTS: A total of 2,442 participants were divided into two groups: no-surgery group (n = 1860) and surgery group (n = 582). Individuals in the no-surgery cohort showed a preference for radiation therapy (29.5% compared to 6.7%), whereas individuals in the surgery cohort were more prone to receiving chemotherapy (71.5% compared to 56.6%) as part of their treatment regimen. Surgery was determined to have a strong correlation with increased rates of OS (hazard ratio (HR) = 0.564, 95% confidence interval (CI) = 0.497-0.639, P < 0.001) and CSS (HR = 0.628, 95% CI 0.539-0.732, P < 0.001) results in BNEC patients. After PSOW, 307 patients were selected for each group. Surgical intervention demonstrated a notable enhancement in OS (P < 0.001) and CSS (P < 0.001) than those patients in the no-surgery group. Among the chemotherapy population, the median survival of patients in the surgery group was significantly higher when compared to those in the no-surgery group. Furthermore, individuals diagnosed with stage I (OS, HR = 0.202, 95% CI 0.112-0.366, P < 0.001; CSS HR = 0.198, 95% CI 0.083-0.472, P < 0.001) and II (OS HR = 0.417, 95% CI 0.331-0.525, P < 0.001; CSS HR = 0.415, 95% CI 0.307-0.561, P < 0.001) tumors who underwent surgical procedures exhibited improved long-term survival rates, whereas no surgical advantage was evident in later stages.
CONCLUSIONS: In the early stages of BNEC, individuals who undergo surgery experience improved survival rates. Therefore, it is important to carefully consider surgical treatment for patients with advanced BNEC.
MATERIALS AND METHODS: Data were gathered from the Surveillance, Epidemiology, and End Results (SEER) database for this retrospective analysis. No-surgery procedures included TURBT, cryotherapy, excisional biopsy, or partial cystectomy. Surgery was categorized as cystectomy, radical cystectomy, or a more complex surgical intervention, such as exenteration. A propensity score overlap weight (PSOW) analysis was performed to adjust statistical influences between the two groups. Prognostic factors related to cancer-specific survival (CSS) and overall survival (OS) were assessed using Cox proportional hazard regression.
RESULTS: A total of 2,442 participants were divided into two groups: no-surgery group (n = 1860) and surgery group (n = 582). Individuals in the no-surgery cohort showed a preference for radiation therapy (29.5% compared to 6.7%), whereas individuals in the surgery cohort were more prone to receiving chemotherapy (71.5% compared to 56.6%) as part of their treatment regimen. Surgery was determined to have a strong correlation with increased rates of OS (hazard ratio (HR) = 0.564, 95% confidence interval (CI) = 0.497-0.639, P < 0.001) and CSS (HR = 0.628, 95% CI 0.539-0.732, P < 0.001) results in BNEC patients. After PSOW, 307 patients were selected for each group. Surgical intervention demonstrated a notable enhancement in OS (P < 0.001) and CSS (P < 0.001) than those patients in the no-surgery group. Among the chemotherapy population, the median survival of patients in the surgery group was significantly higher when compared to those in the no-surgery group. Furthermore, individuals diagnosed with stage I (OS, HR = 0.202, 95% CI 0.112-0.366, P < 0.001; CSS HR = 0.198, 95% CI 0.083-0.472, P < 0.001) and II (OS HR = 0.417, 95% CI 0.331-0.525, P < 0.001; CSS HR = 0.415, 95% CI 0.307-0.561, P < 0.001) tumors who underwent surgical procedures exhibited improved long-term survival rates, whereas no surgical advantage was evident in later stages.
CONCLUSIONS: In the early stages of BNEC, individuals who undergo surgery experience improved survival rates. Therefore, it is important to carefully consider surgical treatment for patients with advanced BNEC.