背景:非肌层浸润性膀胱癌根治性膀胱切除术的指南依从性与患者预后之间的关系目前尚不清楚。我们调查了非肌肉浸润性膀胱癌时的指南依从性是否会影响接受根治性膀胱切除术的膀胱癌患者的肿瘤学结果。
方法:在267例cTa-4N0-2M0膀胱癌患者中,确定了70名在非肌肉浸润性膀胱癌或肌肉浸润性膀胱癌状态下接受根治性膀胱切除术的患者。从最初的经尿道膀胱肿瘤电切术到根治性膀胱切除术遵循指南的患者被定义为指南粘附组(n=52),而非指南非依从组(n=18)。
结果:在指南非粘附组中,18人中有8人(44.4%)被诊断为卡介苗患者的非肌肉浸润性膀胱癌风险最高,7人(38.9%)患有卡介苗无反应的肿瘤状态。指南非坚持组与指南坚持组的五年无复发生存率和癌症特异性生存率分别为38.9%对69.8%(P=0.018)和52.7%对80.1%(P=0.006)。分别。多变量分析确定指南非依从性是疾病复发(风险比=2.81,P=0.008)和癌症特异性死亡(风险比=4.04,P=0.003)的独立指标之一。在根治性膀胱切除术时,对49例cT1或以下非肌层浸润性膀胱癌患者进行的亚组分析中,指南不依从仍然是癌症特异性生存的独立预后因素(风险比=3.46,P=0.027)。
结论:非肌层浸润性膀胱癌分期期间的指南依从性可能导致接受根治性膀胱切除术的患者预后良好。即使在非肌肉浸润性膀胱癌状态下,根据指南建议,根治性膀胱切除术需要在适当的时机进行。
BACKGROUND: The relationship between
guideline adherence for radical cystectomy of non-muscle-invasive bladder cancer and patient prognoses currently remains unclear. We investigated whether
guideline adherence at the time of non-muscle-invasive bladder cancer affects the oncological outcomes of bladder cancer patients who underwent radical cystectomy.
METHODS: Among 267 cTa-4N0-2M0 bladder cancer patients, 70 who underwent radical cystectomy under the non-muscle-invasive bladder cancer or muscle-invasive bladder cancer status that progressed from non-muscle-invasive bladder cancer were identified. Patients who followed the
guidelines from initial transurethral resection of bladder tumors to radical cystectomy were defined as the
guideline adherent group (n = 52), while those who did not were the
guideline non-adherent group (n = 18).
RESULTS: In the guideline non-adherent group, 8 (44.4%) out of 18 were diagnosed with highest risk non-muscle-invasive bladder cancer for Bacillus Calmette Guérin-naïve patients and 7 (38.9%) had a Bacillus Calmette Guérin unresponsive tumor status. Five-year recurrence-free survival and cancer-specific survival rates for the
guideline non-adherent group vs guideline adherent group were 38.9% vs 69.8% (P = 0.018) and 52.7% vs 80.1% (P = 0.006), respectively. A multivariate analysis identified guideline non-adherence as one of independent indicators for disease recurrence (hazard ratio = 2.81, P = 0.008) and cancer-specific death (hazard ratio = 4.04, P = 0.003). In a subgroup analysis of 49 patients with cT1 or less non-muscle-invasive bladder cancer at the time of radical cystectomy, guideline non-adherence remained an independent prognostic factor for cancer-specific survival (hazard ratio = 3.46, P = 0.027).
CONCLUSIONS: Guideline adherence during the time course of the non-muscle-invasive bladder cancer stage may result in a favorable prognosis of patients who receive radical cystectomy. Even under non-muscle-invasive bladder cancer status, radical cystectomy needs to be performed with adequate timing under guideline recommendations.