Department of Urology, Hospital Vall d'Hebron, Barcelona, Spain.
BJU Int. 2010 Jan;105(2):202-7. doi: 10.1111/j.1464-410X.2009.08694.x. Epub 2009 Jun 24.
To determine factors predictive of positive findings at the 3-month follow-up evaluation (after transurethral resection of bladder tumour [TUR] and bacille Calmette-Guérin [BCG] therapy) in patients with initial high-grade (HG)T1 bladder cancer, and to assess the depth of lamina propria (LP) invasion and effectiveness of BCG therapy.
In all, 138 patients with initial HGT1-transitional cell carcinoma (TCC) were prospectively assigned, after TUR + BCG and according to depth of LP invasion, to a postBCG-TUR (T1b) or cystoscopy/cytology (T1a) at 3 months. Any finding at 3 months was considered positive. The predictive value of 11 clinical and pathological variables was assessed by chi-squared, Mann-Whitney U and multivariate logistic regression.
Of the 138 patients (14 women, mean age 69 years), 42% had T1a and 58% T1b TCC. Tumour size and carcinoma in situ (CIS) were significantly associated with positive findings and present in 26% (36/138) of the patients. The postBCG-TUR (T1b cases), was positive in 31% (25/80), including seven infiltrating tumours. On multivariate analysis, again a tumour size of >3 cm (odds ratio, OR, 7.02) and associated CIS (OR 5.4) were significantly related to a positive postBCG-TUR. A secondary finding was that at 20.3 months; patients with T1a TCC, who did not undergo a repeat TUR, did not have increased progression; only 3% (two of 58) had progressed compared with 21% (17/80) of those with T1b/c TCC (P < 0.002).
In initial HGT1-TCC, tumour size and CIS were predictive factors of positive findings at 3 months after the initial TUR + BCG therapy. Patients with HGT1-TCC invading the LP (T1b TCC) had a seven times higher risk of a positive repeat TUR if the initial tumour was >3 cm and a five-fold increased risk if associated with CIS. The repeat TUR after BCG therapy allowed confirmation of complete resection and pathological evaluation of the BCG response. Although data are still preliminary, the strategy of performing a repeat TUR only in cases with LP involvement, i.e. T1b TCC, did not increase the risk of progression in cases with T1a TCC.
确定经尿道膀胱肿瘤切除术（TUR）联合卡介苗（BCG）治疗后初始高级别（HG）T1 膀胱癌患者在 3 个月随访评估（TUR+BCG 后）中阳性发现的预测因素，并评估固有层（LP）浸润深度和 BCG 治疗的效果。
前瞻性地将 138 例初始 HG-T1 移行细胞癌（TCC）患者根据 LP 浸润深度分配至 BCG 后 TUR（T1b）或膀胱镜/细胞学（T1a）组，于 3 个月时进行。任何 3 个月时的发现均被认为是阳性。通过卡方检验、Mann-Whitney U 检验和多变量逻辑回归评估 11 个临床和病理变量的预测价值。
138 例患者（14 例女性，平均年龄 69 岁）中，42%为 T1a，58%为 T1b TCC。肿瘤大小和原位癌（CIS）与阳性发现显著相关，26%（36/138）的患者存在 CIS。BCG 后 TUR（T1b 病例）阳性率为 31%（25/80），包括 7 例浸润性肿瘤。多变量分析再次显示，肿瘤大小>3cm（比值比[OR]，7.02）和伴 CIS（OR 5.4）与 BCG 后 TUR 阳性显著相关。次要发现是，在 20.3 个月时，未行重复 TUR 的 T1a TCC 患者无进展，仅 3%（58 例中的 2 例）进展，而 T1b/c TCC 患者进展率为 21%（80 例中的 17 例）（P<0.002）。
在初始 HG-T1-TCC 中，肿瘤大小和 CIS 是 TUR+BCG 初始治疗后 3 个月阳性发现的预测因素。如果初始肿瘤>3cm，且伴有 CIS，则 LP 浸润（T1b TCC）的 HGT1-TCC 患者重复 TUR 阳性的风险增加 7 倍，如果伴有 CIS，则风险增加 5 倍。BCG 治疗后的重复 TUR 可确认完全切除并对 BCG 反应进行病理评估。尽管数据仍初步，但仅在 LP 受累（即 T1b TCC）的情况下进行重复 TUR 的策略并未增加 T1a TCC 病例的进展风险。
