“Modernized” en Bloc Radical Cystectomy Versus Standard Radical Cystectomy: A Nationwide Multi-Institutional Propensity Score Matched Analysis
Simple Summary
Abstract
1. Introduction
2. Methods
2.1. The Bladder Cancer Pathway in Norway
2.2. Outcomes
2.3. Statistics
3. Results
3.1. Inclusion, Baseline, and Matching
3.2. Surgical and Perioperative Outcomes
3.3. Recurrence-Free, Cancer-Specific, and Overall Survival
3.4. Treatment of Recurrent Disease
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Before Matching | After 1:2 Matching | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
All mEbRC (n = 214) | All stdRC (n = 721) | p-Value | mEbRC Matched (n = 195) | stdRC Matched (n = 390) | p-Value | |||||
Age | 70.9 | (64–77) | 70.4 | (64–75) | 0.44 | 71.5 | (65–75) | 70.0 | (63–74) | 0.57 |
Gender | 0.93 | 1.0 | ||||||||
Male | 169 | (79%) | 565 | (78%) | 158 | (81%) | 315 | (81%) | ||
Female | 45 | (21%) | 156 | (22%) | 37 | (19%) | 75 | (19%) | ||
BMI * | 25.9 | (24–30) | 25.5 | (23–28) | 0.09 | 26.2 | (24–30) | 25.9 | (23–29) | 0.20 |
Clinical N-stage * | ||||||||||
cN+ | 16 | (8%) | 76 | (11%) | 0.24 | 13 | (7%) | 38 | (10%) | 0.28 |
Neoadjuvant chemotherapy | 0.32 | 1.0 | ||||||||
Yes | 76 | (35.5%) | 230 | (32%) | 64 | (33%) | 129 | (33%) | ||
No | 138 | (64.5%) | 491 | (68%) | 131 | (67%) | 261 | (67%) | ||
Charlson Comorbidity Index | ||||||||||
0 | (0–2) | 1 | (0–2) | 0.44 | 0 | (0–1) | 0 | (0–1) | 0.78 | |
Pathological N-stage | <0.001 | |||||||||
pN+ | 24 | (11.2%) | 127 | (17.6%) | 0.03 | 22 | (11.3%) | 49 | (12.6%) | 0.69 |
pN0 | 190 | (89%) | 546 | (76%) | 173 | (89%) | 341 | (87%) | ||
pNx | 48 | (6.7%) | ||||||||
Carcinoma in situ | 0.10 | 0.54 | ||||||||
Yes | 108 | (51%) | 316 | (44%) | 92 | (47%) | 195 | (50%) | ||
No | 106 | (49%) | 405 | (56%) | 103 | (53%) | 195 | (50%) | ||
Pathological stage | 0.75 | 0.43 | ||||||||
pT0 | 64 | (30%) | 208 | (29%) | 0.80 | 59 | (30%) | 118 | (30%) | 1.0 |
pTis | 12 | (5.6%) | 61 | (8.5%) | 0.19 | 12 | (6%) | 39 | (10%) | 0.16 |
pTa | 11 | (5.1%) | 26 | (3.6%) | 0.32 | 11 | (5.6%) | 12 | (3.1%) | 0.17 |
pT1 | 25 | (12%) | 71 | (10%) | 0.44 | 24 | (12%) | 42 | (11%) | 0.58 |
pT2 | 37 | (17%) | 128 | (18%) | 0.92 | 33 | (17%) | 59 | (15%) | 0.63 |
pT3 | 48 | (22%) | 166 | (23%) | 0.93 | 40 | (21%) | 93 | (24%) | 0.40 |
pT4a | 17 | (7.9%) | 61 | (8.5%) | 0.89 | 16 | (8%) | 27 | (7%) | 0.62 |
After 1:2 Matching | |||||
---|---|---|---|---|---|
mEbRC Matched (n = 195) | stdRC Matched (n = 390) | p-Value | |||
High grade cancer | 1.0 | ||||
Yes | 192 | (99%) | 383 | (98%) | |
No | 3 | (2%) | 5 | (1%) | |
N/A | 2 | (1%) | |||
PLND | <0.001 | ||||
Superextended | 14 | (3.6%) | 0.007 | ||
Extended | 115 | (59%) | 90 | (23%) | <0.001 |
Standard | 80 | (41%) | 272 | (70%) | <0.001 |
Limited | 6 | (1.5%) | |||
None/unknown | 8 | (2.1%) | |||
Lymph nodes in final pathology | 17 | (12–23) | 15 | (9–20) | <0.001 |
Extended | 21 | (13–26) | 17 | (12–21) | 0.002 |
Standard | 14 | (11–19) | 14 | (9–20) | 0.91 |
Histologic subtype | 0.66 | ||||
Urothelial carcinoma | 186 | (95%) | 375 | (96%) | |
Squamous cell carcinoma | 4 | (2.1%) | 7 | (1.8%) | |
Adenocarcinoma | 2 | (1.0%) | 4 | (1.0%) | |
Small cell carcinoma | 2 | (0.5%) | |||
Sarcoma | 3 | (1.5%) | 2 | (0.5%) | |
Positive surgical margin | |||||
Yes | 1 | (0.5%) | 19 | (4.9%) | <0.001 |
No | 194 | (99%) | 371 | (95%) | |
Complications | |||||
CL-D 2 | 72 | (37%) | 146 | (37%) | 0.93 |
CL-D 3 | 22 | (11%) | 48 | (12%) | 0.79 |
CL-D 4 | 1 | (0.5%) | 8 | (2.1%) | 0.28 |
Perioperative blood loss (mL) | 300 | (150–450) | 400 | (250–600) | <0.001 |
30-day readmission rate | 23 | (11.8%) | 34 | (8.7) | 0.24 |
Mortality rates | |||||
30-day | 1 | (0.5%) | 4 | (1%) | 0.67 |
90-day | 5 | (2.6%) | 12 | (3.1%) | 0.80 |
After 1:2 Matching | |||||
---|---|---|---|---|---|
mEbRC Matched (n = 195) | stdRC Matched (n = 390) | p-Value | |||
Treatment recurrence | n = 24 | n = 116 | |||
None | 4 | (17%) | 18 | (16%) | 1.0 |
Palliative | 5 | (21%) | 55 | (47%) | 0.02 |
Surgery | 0 | 18 | (16%) | 0.04 | |
Radiation | 4 | (17%) | 39 | (34%) | 0.14 |
Chemotherapy | 12 | (50%) | 54 | (47%) | 0.82 |
Immunotherapy | 8 | (33%) | 11 | (9%) | 0.005 |
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Kjøbli, E.; Haug, E.S.; Salvesen, Ø.; Arstad, C.; Bergesen, A.K.; Brennhovd, B.; Carlsen, B.; Gharib-Alhaug, B.; Gudbrandsdottir, G.; Juliebø-Jones, P.; et al. “Modernized” en Bloc Radical Cystectomy Versus Standard Radical Cystectomy: A Nationwide Multi-Institutional Propensity Score Matched Analysis. Cancers 2025, 17, 404. https://doi.org/10.3390/cancers17030404
Kjøbli E, Haug ES, Salvesen Ø, Arstad C, Bergesen AK, Brennhovd B, Carlsen B, Gharib-Alhaug B, Gudbrandsdottir G, Juliebø-Jones P, et al. “Modernized” en Bloc Radical Cystectomy Versus Standard Radical Cystectomy: A Nationwide Multi-Institutional Propensity Score Matched Analysis. Cancers. 2025; 17(3):404. https://doi.org/10.3390/cancers17030404
Chicago/Turabian StyleKjøbli, Eirik, Erik Skaaheim Haug, Øyvind Salvesen, Christian Arstad, Anne Kvaale Bergesen, Bjørn Brennhovd, Birgitte Carlsen, Bita Gharib-Alhaug, Gigja Gudbrandsdottir, Patrick Juliebø-Jones, and et al. 2025. "“Modernized” en Bloc Radical Cystectomy Versus Standard Radical Cystectomy: A Nationwide Multi-Institutional Propensity Score Matched Analysis" Cancers 17, no. 3: 404. https://doi.org/10.3390/cancers17030404
APA StyleKjøbli, E., Haug, E. S., Salvesen, Ø., Arstad, C., Bergesen, A. K., Brennhovd, B., Carlsen, B., Gharib-Alhaug, B., Gudbrandsdottir, G., Juliebø-Jones, P., Haugland, J. N., Karlsvik, A.-K., Larsen, M., Lilleaasen, G. M., Mûller, S., Plathan, M. L., Roaldsen, M., Roth, I., Schwenke, B. L. L., ... Beisland, C. (2025). “Modernized” en Bloc Radical Cystectomy Versus Standard Radical Cystectomy: A Nationwide Multi-Institutional Propensity Score Matched Analysis. Cancers, 17(3), 404. https://doi.org/10.3390/cancers17030404