膀胱内卡介苗治疗可提高T1G3膀胱肿瘤患者的生存率。

Intravesical Bacillus Calmette-Guerin treatment improves patient survival in T1G3 bladder tumours.

作者信息

Patard Jean-Jacques, Rodriguez Alejandro, Leray Emmanuelle, Rioux-Leclercq Nathalie, Guillé François, Lobel Bernard

机构信息

Department of Urology, CHU, Rennes, France.

出版信息

Eur Urol. 2002 Jun;41(6):635-41; discussion 642. doi: 10.1016/s0302-2838(02)00173-2.

DOI:10.1016/s0302-2838(02)00173-2

PMID:12074781

Abstract

OBJECTIVE

To study the clinical and pathological factors that affect recurrence, progression and survival in pT1G3 bladder tumours treated conservatively.

MATERIAL AND METHODS

From January 1979 to December 1996, 80 patients were conservatively treated for pT1G3 bladder tumours. All patients were studied for potential prognostic factors such as: age, sex, previous tumour recurrence, tumour size, multiple tumours, carcinoma in situ, and intravesical instillations. A longitudinal, retrospective, observational and analytical study was conducted to evaluate four different types of events: recurrence, progression, overall survival, and disease-specific survival. The chi(2) (Fischer exact test) and student t tests were used to assess the prognostic value of the qualitative and quantitative variables. Estimations of the survival distributions were calculated according to the Kaplan-Meier method and compared with the Log rank test. Multivariate analysis of the data was performed with Cox proportional hazard models.

RESULTS

Among the 80 patients, 67 (84%) were men and 13 (16%) were women, with median age of 65.5 years. The median tumour size was 20 mm, most had single tumour (58.8%) and carcinoma in situ was found in six patients (7.5%). Thirty patients were treated with transurethral resection (TUR) of the bladder tumour and 50 patients were treated with TUR followed by BCG. The two groups of patients were comparable and followed up during a median time of 61 and 65 months, respectively (p=0.454). Kaplan-Meier estimators and Log rank tests demonstrated that patients with TUR alone recurred (p<0.0001), progressed (p<0.040) and died (overall survival: p<0.009; disease-specific p<0.040) earlier than patients who received intravesical instillations of BCG. The results were confirmed with Cox models and odds-ratios are presented.

CONCLUSION

In this study, BCG adjuvant immunotherapy was the only factor affecting recurrence, progression and survival. Conservative treatment using TUR followed by BCG may improve disease-specific survival.

摘要

目的

研究保守治疗的pT1G3膀胱肿瘤影响复发、进展及生存的临床和病理因素。

材料与方法

1979年1月至1996年12月，80例pT1G3膀胱肿瘤患者接受了保守治疗。对所有患者研究潜在的预后因素，如：年龄、性别、既往肿瘤复发、肿瘤大小、多发肿瘤、原位癌及膀胱内灌注治疗。开展一项纵向、回顾性、观察性及分析性研究，以评估四种不同类型的事件：复发、进展、总生存及疾病特异性生存。采用卡方检验（费舍尔精确检验）及学生t检验评估定性和定量变量的预后价值。根据Kaplan-Meier方法计算生存分布估计值，并与对数秩检验进行比较。采用Cox比例风险模型对数据进行多变量分析。

结果

80例患者中，67例（84%）为男性，13例（16%）为女性，中位年龄65.5岁。肿瘤中位大小为20mm，多数为单发肿瘤（58.8%），6例患者（7.5%）发现原位癌。30例患者接受经尿道膀胱肿瘤切除术（TUR），50例患者接受TUR后行卡介苗（BCG）灌注治疗。两组患者具有可比性，中位随访时间分别为61个月和65个月（p=0.454）。Kaplan-Meier估计值及对数秩检验表明，单纯接受TUR的患者复发（p<0.0001）、进展（p<0.040）及死亡（总生存：p<0.009；疾病特异性生存：p<0.040）均早于接受膀胱内BCG灌注治疗的患者。Cox模型证实了该结果，并给出了比值比。