Department of Urology, Division of Oncology, University of Michigan, Ann Arbor, MI 48109, USA.
Urology. 2011 Dec;78(6):1345-9. doi: 10.1016/j.urology.2011.05.071. Epub 2011 Oct 11.
To evaluate the use and effectiveness of restaging bladder tumor resection using population-based data. Restaging bladder tumor resection improves staging accuracy and the response to intravesical therapy. However, its use outside of a tertiary care setting, and its subsequent clinical implications, are unknown.
We identified 62 016 patients diagnosed with bladder cancer between 1992 and 2005 using SEER-Medicare data. Restaging bladder tumor resection was defined as 2 or more resections occurring within 60 days of diagnosis. Using multivariable models, we assessed the relationship between the use of restaging resection and cancer-specific survival.
Restaging resection was performed in only 3064 (4.9%) of newly diagnosed bladder cancer patients, but was most common among those with high grade (7.7% vs 2.0% in low grade, P < .001) and stage (8.8% in T2 vs 2.8% in Ta/Tis, P < .001) disease. Compared to patients with muscle-invasive cancers who did not undergo restaging at diagnosis, restaging resection was associated with improved 5-year cancer-specific mortality among pathologically staged patients (20.4% vs 28.0%, P = .02), while clinically staged patients trended toward improved mortality (28.2% vs 31.9%, P = .07).
Restaging transurethral resection for bladder cancer is relatively uncommon and associated with improved survival among patients with muscle invasive bladder cancer. Greater use of restaging warrants further investigation as a simple means of improving outcomes among patients suspected of having muscle invasive disease.
利用基于人群的数据评估再次行膀胱肿瘤切除术的使用情况和效果。再次行膀胱肿瘤切除术可提高分期准确性和膀胱内治疗的反应。然而，其在三级保健环境之外的使用情况及其随后的临床意义尚不清楚。
我们使用 SEER-Medicare 数据确定了 1992 年至 2005 年间诊断为膀胱癌的 62016 例患者。再次行膀胱肿瘤切除术定义为在诊断后 60 天内进行 2 次或更多次切除术。使用多变量模型，我们评估了再次行肿瘤切除术的使用与癌症特异性生存率之间的关系。
仅对 3064 例（4.9%）新诊断膀胱癌患者进行了再次行肿瘤切除术，但在高级别肿瘤（7.7%比低级别肿瘤的 2.0%，P<0.001）和 T2 期肿瘤（8.8%比 Ta/Tis 期肿瘤的 2.8%，P<0.001）患者中最常见。与未在诊断时进行再次行肿瘤切除术的肌层浸润性癌症患者相比，病理分期患者再次行肿瘤切除术与 5 年癌症特异性死亡率的改善相关（20.4%比 28.0%，P=0.02），而临床分期患者的死亡率有改善趋势（28.2%比 31.9%，P=0.07）。
再次行经尿道膀胱肿瘤切除术相对不常见，与肌层浸润性膀胱癌患者的生存改善相关。更多地使用再次行肿瘤切除术作为一种简单的方法来改善疑似肌层浸润性疾病患者的结局是值得进一步研究的。
