Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
BJU Int. 2012 Apr;109(7):1026-30. doi: 10.1111/j.1464-410X.2011.10462.x. Epub 2011 Aug 24.
To assess outcome in patients with T1 high-grade (T1HG) bladder cancer treated at a single academic institution and to determine the prognostic factors that can help in counselling patients towards early cystectomy.
Records of 2570 patients with bladder cancer treated from 1995 to 2005 were reviewed. Only patients diagnosed with T1HG disease were included in the analysis. Collected variables included various clinicopathological parameters, use of statins, smoking, as well as dates of recurrence, progression, radical cystectomy and death. Recurrence-free survival (RFS) and worsening-free survival (WFS) were analyzed. Multivariate Cox proportional regression analysis was employed to verify the prognostic significance of various variables.
In total, 278 (10.8%) patients were identified as having T1HG disease on transurethral resection. 66% of patients who recurred, and 36.3% developed stage progression after a median (range) follow-up of 3 (0.1-15.4) years. 30% patients who underwent radical cystectomy, and 9% were dead of disease. The 5-year RFS and WFS rates were 26.6% and 49.4%, respectively. On multivariate analysis, only non-trigonal tumour location, restaging transurethral resection, history of previous carcinoma not invading bladder muscle and adjuvant bacille Calmette-Guérin (BCG) therapy were significantly associated with prolonged RFS, whereas papillary tumour architecture, history of previous carcinoma not invading bladder muscle and adjuvant BCG therapy were significantly associated with prolonged WFS.
Patients with T1HG bladder cancer are at a significant risk of progression and death from disease. Primary tumours, sessile architecture and trigonal location are factors associated with a worse outcome and may be used to counsel patients towards early cystectomy.
评估在单一学术机构治疗的 T1 高级别（T1HG）膀胱癌患者的结局，并确定有助于向患者提供早期膀胱切除术咨询的预后因素。
回顾了 1995 年至 2005 年期间治疗的 2570 例膀胱癌患者的记录。仅对诊断为 T1HG 疾病的患者进行了分析。收集的变量包括各种临床病理参数、他汀类药物的使用、吸烟以及复发、进展、根治性膀胱切除术和死亡的日期。分析了无复发生存（RFS）和无恶化生存（WFS）。采用多变量 Cox 比例风险回归分析验证了各种变量的预后意义。
共有 278 例（10.8%）患者经经尿道切除术后被诊断为 T1HG 疾病。66%的复发患者和 36.3%的进展患者在中位（范围）随访 3（0.1-15.4）年后出现疾病进展。30%的患者接受了根治性膀胱切除术，9%的患者死于疾病。5 年 RFS 和 WFS 率分别为 26.6%和 49.4%。多变量分析显示，仅非三角区肿瘤位置、再次经尿道切除、非膀胱肌侵犯的既往癌病史和辅助卡介苗（BCG）治疗与延长 RFS 显著相关，而乳头状肿瘤结构、非膀胱肌侵犯的既往癌病史和辅助 BCG 治疗与延长 WFS 显著相关。
T1HG 膀胱癌患者有进展和死于疾病的重大风险。原发性肿瘤、无蒂结构和三角区位置是与较差结局相关的因素，可能用于向患者提供早期膀胱切除术咨询。
