ObjectivesIt is not known whether cancer‐specific mortality (CSM) differences distinguish radical cystectomy (RC) from trimodal therapy (TMT) in octogenarians harbouring organ‐confined (T2N0M0) urothelial cancer of the urinary bladder (UCUB).MethodsWithin the Surveillance, Epidemiology, and End Results database (2004–2021), CSM and other‐cause mortality (OCM) rates were computed in octogenarian patients with organ‐confined UCUB undergoing either TMT or RC. Smoothed cumulative incidence plots depicted 5‐year CSM and OCM rates according to RC vs TMT. Competing risks regression (CRR) models were fitted, adjusting for age, gender, and race/ethnicity. Nearest‐neighbour 1:1 propensity‐score matching (PSM) for age and gender was also applied. Sensitivity analyses were additionally performed, focusing on White patients.ResultsOf 2335 octogenarian patients with T2N0M0 UCUB, 1562 (66.3%) received TMT and 793 (33.7%) received RC. Of those, 2082 (88.4%) were White. TMT rates increased from 53.5% in 2004 to 82.2% in 2021 (P < 0.001). The 5‐year CSM rate was 50.1% for TMT vs 31.1% for RC. After multivariable CRR, TMT independently predicted 1.7‐fold higher CSM (P < 0.001). After additional PSM, TMT also independently predicted 1.7‐fold higher CSM (P < 0.001). In sensitivity analyses exclusively focusing on White patients, almost identical results were recorded.ConclusionRates of TMT have nearly doubled in octogenarian patients with organ‐confined UCUB in recent years; however, CSM rates after TMT are also nearly twice as high as those observed after RC. It is crucial to communicate these observations.

中文翻译：

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八旬老人器官局限型尿路上皮膀胱癌三峰治疗后的生存率


目的尚不清楚癌症特异性死亡率 （CSM） 差异是否区分了患有器官限制性 （T2N0M0） 尿路上皮癌 （UCUB） 的八旬老人根治性膀胱切除术 （RC） 和三峰疗法 （TMT）。方法在监测、流行病学和最终结果数据库 （2004-2021） 中，计算了接受 TMT 或 RC 的器官限制性 UCUB 的八十多岁患者的 CSM 和其他原因死亡率 （OCM） 率。平滑的累积发生率图根据 RC 与 TMT 描述了 5 年 CSM 和 OCM 率。拟合竞争风险回归 （CRR） 模型，根据年龄、性别和种族/民族进行调整。还应用了年龄和性别的最近邻 1：1 倾向得分匹配 （PSM）。此外还进行了敏感性分析，重点是白人患者。结果在 2335 例八十多岁的 T2N0M0 UCUB 患者中，1562 例 （66.3%） 接受 TMT，793 例 （33.7%） 接受 RC。其中，2082 人 （88.4%） 是白人。TMT 率从 2004 年的 53.5% 增加到 2021 年的 82.2% （P < 0.001）。TMT 的 5 年 CSM 率为 50.1%，而 RC 为 31.1%。多变量 CRR 后，TMT 独立预测 CSM 高出 1.7 倍 （P < 0.001）。在额外的 PSM 后，TMT 也独立预测 CSM 高出 1.7 倍 （P < 0.001）。在仅针对白人患者的敏感性分析中，记录了几乎相同的结果。结论近年来，八十多岁器官局限型 UCUB 患者的 TMT 发生率几乎翻了一番;然而，TMT 后的 CSM 发生率也几乎是 RC 后观察到的 CSM 发生率的两倍。传达这些观察结果至关重要。