在前瞻性试验中，三模式治疗（TMT）相对于单独的外照射放射治疗（EBRT）具有显着的生存优势。然而，生存获益的程度尚未在基于人群的研究中得到验证。本研究的目的是确定相对于 EBRT 而言，TMT 是否与较低的癌症特异性死亡率 (CSM) 相关。在监测、流行病学和最终结果数据库（2004-2020）中，我们确定了患有 cT2-T4aN0M0 尿路上皮的患者采用 TMT 或 EBRT 治疗膀胱癌 (UCUB)。在对其他原因死亡率和标准协变量进行额外调整后，累积发生率图和多变量竞争风险回归 (CRR) 模型解决了 CSM。根据分期和年龄类别重复相同的方法。在 4471 名患者中，3391 名 (76%) 接受了 TMT，而 1080 名 (24%) 接受了 EBRT。在整个队列中，TMT 率随着时间的推移而增加（估计年度百分比变化 [EAPC]：1.8%，p < 0.001）以及器官限制 (OC) 阶段（EAPC：1.7%，p < 0.001），但在非器官限制 (NOC) 阶段 (p = 0.051)。在整个队列中，TMT 的 5 年 CSM 率为 43.6%，而 EBRT 的 5 年 CSM 率为 52.7%。在多变量 CRR 模型中，TMT 是较低 CSM 的独立预测因子（风险比 [HR]：0.76，p < 0.001）。在 OC 患者中，TMT 组的 5 年 CSM 率为 42.0%，而 EBRT 组的 5 年 CSM 率为 51.9%（p < 0.001）。在多变量 CRR 模型中，TMT 是较低 CSM 的独立预测因子（HR：0.74，p < 0.001）。相反，在 NOC 患者中，TMT 并未达到独立预测状态 (p = 0.3)。在这项基于人群的研究中，相对于 EBRT，TMT 与 OC 期较低的 CSM 相关，但在 NOC UCUB 患者中则不然。在本报告中，我们研究了对于膀胱保留策略候选者，除了放疗之外，进行全身化疗的生存获益。我们发现，与单独放疗相比，全身化疗和放疗相结合可改善器官局限性尿路上皮癌患者的癌症特异性生存率。我们的结论是，对于适合膀胱保留策略的患者，经尿道切除术后，应始终对器官局限性尿路上皮癌患者提供放疗和化疗联合治疗（即三模式治疗）。版权所有 © 2024 欧洲泌尿外科协会。由 Elsevier B.V. 出版。保留所有权利。

Trimodal therapy (TMT) provided significant survival advantage relative to external beam radiation therapy (EBRT) alone in prospective trials. However, the magnitude of survival benefit has not been validated in population-based studies. The objective of this study is to determine whether TMT is associated with lower cancer-specific mortality (CSM) rates relative to EBRT.Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified patients with cT2-T4aN0M0 urothelial carcinoma of urinary bladder (UCUB) treated with either TMT or EBRT. Cumulative incidence plots and multivariable competing risk regression (CRR) models addressed CSM after additional adjustment for other-cause mortality and standard covariates. The same methodology was repeated according to stage and age categories.Of 4471 patients, 3391 (76%) underwent TMT versus 1080 (24%) EBRT. TMT rates increased over time in the overall cohort (estimated annual percent change [EAPC]: 1.8%, p < 0.001) as well as in organ-confined (OC) stage (EAPC: 1.7%, p < 0.001), but not in non-organ-confined (NOC) stage (p = 0.051). In the overall cohort, 5-yr CSM rates were 43.6% in TMT versus 52.7% in EBRT. In multivariable CRR models, TMT was an independent predictor of lower CSM (hazard ratio [HR]: 0.76, p < 0.001). In OC patients, 5-yr CSM rates were 42.0% in TMT versus 51.9% in EBRT (p < 0.001). In multivariable CRR models, TMT was an independent predictor of lower CSM (HR: 0.74, p < 0.001). Conversely, in NOC patients, TMT did not achieve independent predictor status (p = 0.3).In this population-based study, relative to EBRT, TMT is associated with lower CSM in OC stage, but not in NOC UCUB patients.In this report, we investigated the survival benefit of administering systemic chemotherapy in addition to radiotherapy in patients who are candidates for bladder-sparing strategies. We found that the combination of systemic chemotherapy and radiotherapy leads to improved cancer-specific survival compared with radiotherapy alone in patients with organ-confined urothelial carcinoma. We conclude that among patients who are candidates for bladder-sparing strategies, following transurethral resection, the combination of radiotherapy and chemotherapy (namely, trimodal therapy) should always be offered in those with organ-confined urothelial carcinoma.Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.