目的:肌层浸润性膀胱癌是一种侵袭性疾病。然而,许多患者,尤其是那些有高龄和多种合并症的人,不要接受治愈性治疗。我们评估了这些患者的病程和医疗保健负担。
方法:双中心,回顾性分析2016-2021年间未接受根治性治疗(根治性膀胱切除术或三模态治疗)的肌层浸润性膀胱癌患者.描述了患者特征和治疗负担。无转移,癌症特异性,使用Kaplan-Meier方法评估总生存率。
结果:评估了66例中位年龄为86岁(IQR78,90)的患者。幸存者的中位随访时间为29个月(IQR9,44)。所有患者均诊断为肌层浸润性膀胱癌,32例(48%)出现临床T3和T4疾病。诊断时年龄校正的Charlson合并症指数中位数为7(IQR6,8)。由于58例患者(88%)的合并症和低性能状态以及8例(12%)的患者拒绝,未提供治愈性治疗。两年估计无转移生存率,癌症特异性生存率,总生存率为11%,18%,12%,分别。随访期间,7例患者(10%)接受化疗,4人(6%)接受免疫治疗,21(32%)辐射,17例(26%)因血尿而紧急手术。24名患者(37%)需要肾造瘘管,39(59%)需要在不同时期留置导尿管。43例患者(65%)患有复发性血尿发作。总的来说,急诊室就诊次数中位数为4次(IQR2、6),中位住院时间为16天(IQR9,29).
结论:未经治疗的肌层浸润性膀胱癌与患者和卫生系统的有限寿命和高疾病负担相关。当选择避免治愈性治疗时,应考虑并向患者描绘这些数据。
OBJECTIVE: Muscle-invasive bladder cancer is an aggressive disease. Yet, many patients, especially those with advanced age and multiple comorbidities, do not receive treatment with curative intent. We evaluated the disease course and health care burden of these patients.
METHODS: Bi-center, retrospective analysis of patients diagnosed with muscle-invasive bladder cancer who did not undergo curative-intent treatment (radical cystectomy or trimodal therapy) between 2016 and 2021. Patient characteristics and treatment burden were described. Metastasis-free, cancer-specific, and overall survivals were evaluated using the Kaplan-Meier method.
RESULTS: Sixty-six patients with a median age of 86 (IQR 78,90) were evaluated. The median follow-up for survivors was 29 months (IQR 9, 44). All patients were diagnosed with muscle-invasive bladder cancer, and 32 (48%) presented with clinical T3 and T4 disease. The median age adjusted Charlson comorbidity index at diagnosis was 7 (IQR 6,8). Treatment with curative intent was not provided due to comorbidities and low-performance status in 58 patients (88%) and patient refusal in 8 (12%). Two-year estimated metastasis-free survival, cancer-specific survival, and overall survival were 11%, 18%, and 12%, respectively. During follow-up, 7 patients (10%) were treated with chemotherapy, 4 (6%) received immunotherapy, 21 (32%) radiation, and 17 (26%) had emergent operations due to hematuria. Twenty-four patients (37%) required nephrostomy tubes, and 39 (59%) required an indwelling urinary catheter for various periods. Forty-three patients (65%) suffered from recurrent hematuria episodes. Overall, median emergency room visits were 4 (IQR 2, 6), and median hospital admission was 16 days (IQR 9, 29).
CONCLUSIONS: Untreated muscle-invasive bladder cancer is associated with a limited lifespan and a high disease burden for the patient and health system. These data should be taken into consideration and portrayed to the patient when curative intent treatment is chosen to be avoided.