Palou-Redorta Juan, Rouprêt Morgan, Gallagher Jack R, Heap Kylee, Corbell Catherine, Schwartz Brent
Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Calle Cartagena 340-350, 08025, Barcelona, Spain.
World J Urol. 2014 Apr;32(2):525-30. doi: 10.1007/s00345-013-1142-z. Epub 2013 Aug 2.
The aim of this study was to assess the use of immediate postoperative instillation of intravesical chemotherapy (IPOIC) after transurethral resection of bladder tumour (TURBT) of nonmuscle invasive bladder cancer (NMIBC) in Europe.
Urologists based in five European Union nations were asked to extract information from the records of patients with NMIBC-urothelial carcinoma who received at least one TURBT. Multivariate logistic regression models were developed to determine the significant predictors of IPOIC usage. Data were weighted to control for country-to-country and other differences.
Overall, 324 urologists (58 France, 72 Germany, 62 Italy, 65 Spain, 67 United Kingdom) were involved; the participation rate was 55 %. Overall, 771 patients received 954 TURBTs (mean-1.2/patient), of which 413 of the TURBTs (43.3 %) were administered IPOIC . Sixty-six of the 413 IPOICs (16.0 %) were for a recurrent tumour. Five of the tested variables were significantly associated with a patient's likelihood of receiving IPOIC after TURBT. Variables in the order of significance are as follows: (1) country (United Kingdom, patients most likely to receive IPOIC; France, least likely); (2) progression risk (physician assessed) [lower-risk conditions (no CIS, tumour < 3 cm) or intermediate risk-more likely]; (3) whether urologist completed a uro-oncology fellowship (completed-more likely); (4) recurrence risk (physician assessed) [higher-risk conditions (≥T2, ≥3 cm, CIS)-more likely]; and (5) physician's NMIBC patients volume (higher volume-more likely).
This study revealed wide practice variation and substantial noncompliance with European Association of Urology Guidelines on the use of IPOIC after TURBT for NMIBC.
本研究旨在评估欧洲非肌层浸润性膀胱癌（NMIBC）经尿道膀胱肿瘤电切术（TURBT）后即刻膀胱内灌注化疗（IPOIC）的使用情况。
邀请来自五个欧盟国家的泌尿科医生从接受至少一次TURBT的NMIBC-尿路上皮癌患者的记录中提取信息。建立多变量逻辑回归模型以确定IPOIC使用的显著预测因素。对数据进行加权以控制国家间及其他差异。
总体而言，共有324名泌尿科医生（法国58名、德国72名、意大利62名、西班牙65名、英国67名）参与；参与率为55%。总体而言，771例患者接受了954次TURBT（平均每位患者1.2次），其中413次TURBT（43.3%）进行了IPOIC。413次IPOIC中有66次（16.0%）用于复发性肿瘤。所测试的五个变量与患者TURBT后接受IPOIC的可能性显著相关。按重要性顺序排列的变量如下：（1）国家（英国，患者接受IPOIC的可能性最高；法国，可能性最低）；（2）进展风险（医生评估）[低风险情况（无原位癌，肿瘤<3 cm）或中风险 - 更有可能]；（3）泌尿科医生是否完成了泌尿肿瘤学 fellowship（完成 - 更有可能）；（4）复发风险（医生评估）[高风险情况（≥T2，≥3 cm，原位癌） - 更有可能]；（5）医生的NMIBC患者数量（数量越多 - 更有可能）。
本研究揭示了在TURBT后使用IPOIC治疗NMIBC方面，临床实践存在广泛差异且大量不遵循欧洲泌尿外科学会指南的情况。
