对接受三模式治疗 (TMT) 的肌层浸润性膀胱癌 (MIBC) 患者进行选择性盆腔淋巴结照射存在争议。在淋巴结阴性 (N0) MIBC 患者中，选择性全骨盆同步放化疗 (WP-CCR) 与仅膀胱放化疗 (BO)-CCR 相比的益处尚未得到证实。使用来自国家癌症数据库 (NCDB) 的真实世界数据，我们试图比较 BO-CCR 和 WP-CCR 之间 MIBC 的总生存期 (OS)。使用 2020 年 NCDB 参与者用户文件，我们确定了诊断为 MIBC 的病例2017年和2019年。我们选择接受CCR作为一线治疗的临床T2-T4aN0M0疾病患者。 CCR 的定义是经尿道切除膀胱肿瘤，然后对膀胱进行≥40 Gy 的放射治疗，同时进行单药或多药化疗。根据选择性淋巴结照射状态，将患者分为接受 BO-CCR 与 WPCCR 的患者。使用总结的三个月条件标志、逆概率治疗权重 (IPTW) 调整的 Kaplan-Meier 估计和 Cox 回归进行 OS 分析。总共确定了 604 名因 MIBC 接受 CCR 的患者：367 名 (60.8%) BO-CCR 和237 (39.2%) WP-CCR。在 IPTW 之前，各组在基线特征方面不平衡。加权人群的中位随访时间为 42.3 个月（四分位距 [IQR] 18.1-49.1 个月）。在 IPTW 调整的 Cox 比例风险回归分析中，与 BO-CCR 相比，WP-CCR 与显着的 OS 获益相关（调整后的风险比 0.72，95% 置信区间 0.54-0.96，p=0.026）。 N0 MIBC，这项回顾性 NCDB 分析显示，与 BO-CCR 相比，WP-CCR 与 OS 获益相关。

Elective pelvic nodal irradiation for patients with muscle-invasive bladder cancer (MIBC) undergoing trimodal therapy (TMT) is controversial. In patients with node-negative (N0) MIBC, the benefit of elective whole-pelvis concurrent chemoradiation (WP-CCR) compared to bladder-only (BO)-CCR has not been demonstrated. Using real-world data from the National Cancer Database (NCDB), we sought to compare the overall survival (OS) between BO-CCR and WP-CCR for MIBC.Using the 2020 NCDB Participant User File, we identified cases of MIBC diagnosed between 2017 and 2019. We selected patients with clinical T2-T4aN0M0 disease receiving CCR as first-line treatment. CCR was defined as transurethral resection of bladder tumor followed by ≥40 Gy radiation to the bladder with concurrent single- or multiple-agent chemotherapy. Based on elective nodal irradiation status, patients were stratified as having received BO-CCR vs. WPCCR. OS analysis was performed using summary three-month conditional landmark, inverse probability treatment weighting (IPTW)-adjusted Kaplan-Meier estimates and Cox regression.A total of 604 patients receiving CCR for MIBC were identified: 367 (60.8%) BO-CCR and 237 (39.2%) WP-CCR. Before IPTW, the groups were imbalanced in terms of baseline characteristics. The median followup of the weighted population was 42.3 months (interquartile range [IQR] 18.1-49.1 months). In IPTW-adjusted Cox proportional hazards regression analysis, WP-CCR was associated with a significant OS benefit compared to BO-CCR (adjusted hazard ratio 0.72, 95% confidence interval 0.54-0.96, p=0.026).In the setting of CCR for N0 MIBC, this retrospective NCDB analysis revealed that WP-CCR was associated with a benefit in OS compared to BO-CCR.