β-阻斷劑使用是否影響尿路上皮癌患者的整體存活率？

基於TriNetX全球資料庫的傾向性分數配對分析

曾華緯、曾文歆、黃冠華

奇美醫療財團法人奇美醫院 外科部 泌尿科

Does Beta-Blocker Use Influence Overall Survival in Urothelial Carcinoma? A Propensity Score–Matched Analysis Using the TriNetX Global Network

Hua-Wei Tseng, Wen-Hsin Tseng, Steven K. Huang

Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

Purpose: Although several observational studies have suggested that β-adrenergic blockade might improve cancer-specific survival in urothelial carcinoma (UC), these benefits have not extended to overall survival (OS). The clinical relevance of β-blocker use in real-world UC management therefore remains uncertain. This study aimed to validate and expand upon previous findings by examining the association between β-blocker exposure and OS among patients with UC using a large, international real-world database.

Materials and Methods: Data were extracted from the TriNetX Global Collaborative Network, encompassing electronic health records from 162 healthcare organizations worldwide. Two cohorts were defined: patients with UC who received β-blockers within 90 days prior to UC diagnosis (n=4,637) and those without β-blocker exposure (n=12,011). After 1:1 propensity-score matching for demographics, cardiovascular comorbidities, procedures, and laboratory parameters, 3,321 patients per group were analyzed. The primary endpoint was overall survival, assessed using Kaplan–Meier estimation and Cox proportional-hazards modeling. Follow-up began one day after UC diagnosis and continued until death or last recorded contact.

Results: Before matching, β-blocker users were older and had a higher prevalence of cardiovascular comorbidities. After matching, baseline characteristics—including major cardiovascular conditions—were well balanced between cohorts. Median follow-up durations were 1,186 days for β-blocker users and 749 days for non-users. Mortality risks were 42.0 % in the β-blocker group and 36.5 % in the non-user group (risk difference = 0.054; 95 % CI 0.031–0.078; p < 0.001). Median OS was 2,607 days vs. 2,662 days, respectively, with no statistically significant difference (log-rank p = 0.157). The adjusted hazard ratio for death was 0.946 (95 % CI 0.876–1.022), indicating no OS benefit.

Conclusions: In this large, multinational real-world cohort, β-blocker exposure within 90 days before UC diagnosis was not associated with improved overall survival, even after rigorous propensity-score matching for cardiovascular comorbidities. These results strengthen the evidence that the hypothesized antitumor effects of β-adrenergic blockade may have limited clinical relevance in real-world UC management. The observed trend toward higher all-cause mortality among β-blocker users likely reflects the underlying cardiovascular burden requiring pharmacologic management, which may counterbalance any potential oncologic advantage. Further studies are warranted to clarify whether specific β-blocker subclasses or disease stages modify this association.