Cancer-Specific Mortality of Partial Cystectomy Versus Radical Cystectomy in T2N0M0 Urothelial Bladder Cancer

Background: The authors hypothesized that for T2N0M0 urothelial carcinoma of urinary bladder (UCUB) patients, partial cystectomy (PC) does not differ from radical cystectomy (RC) regarding cancer-specific mortality (CSM). Methods: Within the Surveillance, Epidemiology and End Results (SEER) database (2004-2021), rates of PC versus RC for T2N0M0 UCUB patients were tabulated. Nearest-neighbor 1:1 propensity score-matching (PSM) for age, sex, tumor size and site, race/ethnicity, chemotherapy, and pelvic lymph node dissection status was applied. Poisson-smoothed cumulative incidence plots depicted 5-year CSM and other-cause mortality (OCM) rates. Uni- and multivariable competing-risks regression (CRR) models were fitted. Sensitivity analyses were performed for patients with tumors ≤ 3 cm, tumors amenable to segmental resection (outside trigone, ureteric orifices, or bladder neck), or both. Results: Of 5425 T2N0M0 UCUB patients, 412 (7.6%) received PC versus 5013 (92.4%) who received RC. The PC rates decreased from 12.1% in 2004 to 6.2% in 2021 (p < 0.001). After PSM, the 5 year CSM rate was 26.7% for PC versus 28.4% for RC, and after ultivariable CRR, PC was unrelated to CSM rates (multivariable hazard ratio [mHR], 0.9; p = 0.2). In separate sensitivity analyses of 3187 (58.7%) patients with tumors ≤ 3 cm, 2521 (46.5%), patients with tumors amenable to segmental resection, and 1416 (26.1%) patients with both, after reapplication of PSM and additional multivariable adjustment, virtually the same results were observed. Conclusion: A small proportion of T2N0M0 UCUB patients underwent PC instead of RC. However, for well-selected patients, PC was not associated with worse cancer control outcomes than RC.