Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan.
BJU Int. 2011 May;107(10):1598-604. doi: 10.1111/j.1464-410X.2010.09850.x. Epub 2010 Nov 18.
• To validate the European Association of Urology (EAU) guidelines on risk group stratification to predict recurrence in Japanese patients with stage Ta and T1 bladder tumours.
• A cohort of 592 Japanese patients who were treated with transurethral resection (TUR) and histopathologically diagnosed with Ta and T1 urothelial carcinoma of the bladder were enrolled in this retrospective study. • The primary endpoint of the present study was recurrence-free survival, and the median follow-up duration was 37 months in recurrence-free survivors.
• Multivariate Cox proportional hazards regression analysis showed that the Eastern Cooperative Oncology Group performance status (ECOG PS), prior recurrence rate, number of tumours and T category were independent predictors of time to recurrence (P < 0.05). According to the EAU guidelines for predicting recurrence, the vast majority of Japanese patients were classified into intermediate risk. • The intermediate-risk patients were further divided into intermediate-low-risk and intermediate-high-risk subgroups based on the European Organization for Research and Treatment of Cancer risk table, and a significant difference in the recurrence-free survival rates was found between these subgroups (P < 0.001). • It was also found that patients with high risk combined with intermediate-high risk had significantly poorer recurrence-free survival rates than those with low risk combined with intermediate-low risk (P < 0.001).
• This is the first report on the ECOG PS as a potentially useful predictor for bladder tumour recurrence. • The risk group stratification of the EAU guidelines for recurrence might not be applicable to Japanese patients with Ta and T1 bladder tumours, but the subgroup classification of intermediate risk could be appropriate.
本回顾性研究纳入了 592 例接受经尿道切除术（TUR）治疗且组织病理学诊断为 Ta 和 T1 膀胱尿路上皮癌的日本患者。
本研究的主要终点是无复发生存率，无复发生存者的中位随访时间为 37 个月。
多变量 Cox 比例风险回归分析显示，东部肿瘤协作组体能状态（ECOG PS）、既往复发率、肿瘤数量和 T 分期是复发时间的独立预测因素（P<0.05）。根据 EAU 预测复发的指南，绝大多数日本患者被归类为中危。
根据欧洲癌症研究与治疗组织风险表，将中危患者进一步分为中低危和中高危亚组，这些亚组之间无复发生存率存在显著差异（P<0.001）。
还发现，高风险合并中高危的患者无复发生存率明显低于低风险合并中低危的患者（P<0.001）。
这是首次报道 ECOG PS 作为膀胱癌复发的一个潜在有用预测因子。
EAU 指南的复发风险分层可能不适用于日本 Ta 和 T1 期膀胱癌患者，但中危的亚组分类可能是合适的。
