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初发、复发和进展性高危非肌层浸润性膀胱癌的比较结局。

Comparative outcomes of primary, recurrent, and progressive high-risk non-muscle-invasive bladder cancer.

机构信息

The Academic Urology Unit, University of Sheffield, UK.

出版信息

Eur Urol. 2013 Jan;63(1):145-54. doi: 10.1016/j.eururo.2012.08.064. Epub 2012 Sep 5.

Abstract

BACKGROUND

The treatment of high-risk non-muscle-invasive bladder cancer (BCa) is problematic given the variable natural history of the disease. Few reports have compared outcomes for primary high-risk tumours with those that develop following previous BCas (relapses). The latter represent a self-selected cohort, having failed previous treatments.

OBJECTIVE

To compare outcomes in patients with primary, progressive, and recurrent high-risk non-muscle-invasive BCa.

DESIGN, SETTING, AND PARTICIPANTS: We identified all patients with primary and relapsing high-risk BCa tumours at our institution since 1994. Relapses were divided into progressive (previous low- or intermediate-risk disease) and recurrent (previous high-risk disease) cancers.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Relationships with outcome analysed using multivariable Cox regression and log-rank analysis.

RESULTS AND LIMITATIONS

We identified 699 primary, 110 progressive, and 494 recurrent high-risk BCa tumours in 809 patients (average follow-up: 59 mo [interquartile range: 6-190]). Muscle invasion occurred most commonly in recurrent (23%) tumours, when compared to progressive (20%) and primary (14.6%) cohorts (log rank p<0.001). Disease-specific mortality (DSM) occurred more frequently in patients with recurrent (25.5%) and progressive (24.6%) tumours compared to primary disease (19.2%; log rank p=0.006). Other-cause mortality was similar in all groups (log rank p=0.57), and overall mortality was highest in the progressive cohort (62%) compared with the recurrent (58%) and primary groups (54%; log rank p<0.001). In multivariable analysis, progression and DSM were predicted by tumour grouping (hazard ratio [HR]: >1.15; p<0.026), stage (HR: >1.30; p<0.001), and patient age and sex (HR: >1.03; p<0.037). Carcinoma in situ was only predictive of outcome in primary tumors. Limitations include retrospective design and limited details regarding bacillus Camille-Guérin use.

CONCLUSIONS

Patients with relapsing, high-risk, BCa tumors have higher progression, DSM, and overall mortality rates than those with primary cancers. The use of bladder-sparing strategies in these patients should approached cautiously. Carcinoma in situ has little predicative role in relapsing, high-risk, BCa tumors.

摘要

背景

由于疾病的自然史存在差异,高危非肌肉浸润性膀胱癌(BCa)的治疗颇具挑战性。鲜有研究比较过原发性高危肿瘤与先前 BCa (复发)后发展的肿瘤的结果。后者代表了既往治疗失败的自我选择队列。

目的

比较原发性、进展性和复发性高危非肌肉浸润性膀胱癌患者的结局。

设计、地点和参与者:我们在我院自 1994 年以来确定了所有患有原发性和复发性高危 BCa 肿瘤的患者。复发分为进展性(既往低或中危疾病)和复发性(既往高危疾病)癌症。

结局测量和统计学分析

使用多变量 Cox 回归和对数秩分析来分析与结局的关系。

结果和局限性

我们在 809 例患者中确定了 699 例原发性、110 例进展性和 494 例复发性高危 BCa 肿瘤(平均随访时间:59 个月[四分位距:6-190])。与进展性(20%)和原发性(14.6%)队列相比,复发性(23%)肿瘤中更常见肌肉浸润(对数秩 p<0.001)。与原发性疾病(19.2%;对数秩 p=0.006)相比,复发性(25.5%)和进展性(24.6%)肿瘤患者的疾病特异性死亡率(DSM)更为常见。所有组的其他原因死亡率相似(对数秩 p=0.57),进展性队列的总死亡率最高(62%),其次是复发性队列(58%)和原发性队列(54%;对数秩 p<0.001)。在多变量分析中,肿瘤分组(风险比[HR]:>1.15;p<0.026)、分期(HR:>1.30;p<0.001)和患者年龄和性别(HR:>1.03;p<0.037)预测了进展和 DSM。原位癌仅预测原发性肿瘤的结局。局限性包括回顾性设计和卡介苗使用的详细信息有限。

结论

与原发性癌症患者相比,复发性高危 BCa 肿瘤患者的进展、DSM 和总死亡率更高。在这些患者中使用保膀胱策略应谨慎。原位癌在复发性高危 BCa 肿瘤中几乎没有预测作用。

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