TY - JOUR
T1 - Oncological outcomes of prophylactic urethrectomy at the time of radical cystectomy for bladder cancer
T2 - A nationwide multi-institutional study
AU - the Japan Urological Oncology Group
AU - Miki, Jun
AU - Fukuokaya, Wataru
AU - Taoka, Rikiya
AU - Saito, Ryoichi
AU - Matsui, Yoshiyuki
AU - Hatakeyama, Shingo
AU - Kawahara, Takashi
AU - Matsuda, Ayumu
AU - Kawai, Taketo
AU - Kato, Minoru
AU - Sazuka, Tomokazu
AU - Sano, Takeshi
AU - Urabe, Fumihiko
AU - Kashima, Soki
AU - Naito, Hirohito
AU - Murakami, Yoji
AU - Nishiyama, Naotaka
AU - Nishiyama, Hiroyuki
AU - Kitamura, Hiroshi
AU - Kimura, Takahiro
N1 - Publisher Copyright:
© 2024 The Japanese Urological Association.
PY - 2024/9
Y1 - 2024/9
N2 - Objectives: To determine the effects of prophylactic urethrectomy (PU) on oncological and perioperative outcomes in patients with bladder cancer (BC) undergoing radical cystectomy (RC). Methods: This retrospective study analyzed data on 1976 evaluable patients with BC who underwent RC. Patients were drawn from 36 institutions within the Japanese Urological Oncology Group. Oncological outcomes were compared using restricted mean survival times (RMSTs) based on inverse probability of treatment weighting (IPTW)-adjusted Kaplan–Meier curves for non-urinary tract recurrence-free survival (NUTRFS), cancer-specific survival (CSS), and overall survival (OS). Interaction terms within IPTW-adjusted Cox regression models were examined to assess the heterogeneity of treatment effect based on the risk of urethral recurrence (UR). The association between PU, estimated blood loss (EBL), and the incidence of severe postoperative surgical complications (SPSCs) (Clavien-Dindo grade 3 or higher) was analyzed. Results: Of 1976 patients, 1448 (73.3%) received PU. IPTW adjustment was used to balance baseline characteristics between the treatment groups. Within the 107-month window of patient monitoring, PU showed no survival benefits (NUTRFS difference: 0.2 months [95% confidence interval: −6.8 to 7.3]; CSS, 1.2 [−4.9 to 7.3]; OS, 0 [−6.5 to 6.5]). No significant interactions were observed with factors associated with UR, and PU was associated with unfavorable perioperative outcomes (EBL, 1179 mL vs. 983 mL; SPSC, 14.6% vs. 7.0%). Conclusions: This study showed that (1) PU was not associated with survival in patients with BC undergoing RC, regardless of UR-associated factors, and (2) PU was associated with unfavorable perioperative outcomes.
AB - Objectives: To determine the effects of prophylactic urethrectomy (PU) on oncological and perioperative outcomes in patients with bladder cancer (BC) undergoing radical cystectomy (RC). Methods: This retrospective study analyzed data on 1976 evaluable patients with BC who underwent RC. Patients were drawn from 36 institutions within the Japanese Urological Oncology Group. Oncological outcomes were compared using restricted mean survival times (RMSTs) based on inverse probability of treatment weighting (IPTW)-adjusted Kaplan–Meier curves for non-urinary tract recurrence-free survival (NUTRFS), cancer-specific survival (CSS), and overall survival (OS). Interaction terms within IPTW-adjusted Cox regression models were examined to assess the heterogeneity of treatment effect based on the risk of urethral recurrence (UR). The association between PU, estimated blood loss (EBL), and the incidence of severe postoperative surgical complications (SPSCs) (Clavien-Dindo grade 3 or higher) was analyzed. Results: Of 1976 patients, 1448 (73.3%) received PU. IPTW adjustment was used to balance baseline characteristics between the treatment groups. Within the 107-month window of patient monitoring, PU showed no survival benefits (NUTRFS difference: 0.2 months [95% confidence interval: −6.8 to 7.3]; CSS, 1.2 [−4.9 to 7.3]; OS, 0 [−6.5 to 6.5]). No significant interactions were observed with factors associated with UR, and PU was associated with unfavorable perioperative outcomes (EBL, 1179 mL vs. 983 mL; SPSC, 14.6% vs. 7.0%). Conclusions: This study showed that (1) PU was not associated with survival in patients with BC undergoing RC, regardless of UR-associated factors, and (2) PU was associated with unfavorable perioperative outcomes.
KW - bladder cancer
KW - radical cystectomy
KW - urethrectomy
KW - urinary diversion
UR - http://www.scopus.com/inward/record.url?scp=85195108778&partnerID=8YFLogxK
U2 - 10.1111/iju.15505
DO - 10.1111/iju.15505
M3 - 学術論文
C2 - 38822533
AN - SCOPUS:85195108778
SN - 0919-8172
VL - 31
SP - 1009
EP - 1016
JO - International Journal of Urology
JF - International Journal of Urology
IS - 9
ER -