Urology Department, Brighton and Sussex University Hospitals, Brighton, UK.
BJU Int. 2014 May;113(5b):E22-7. doi: 10.1111/bju.12334. Epub 2013 Dec 20.
To evaluate the prognostic value of inflammation or granuloma after intravesical bacille Calmette-Guérin (BCG) treatment in non-muscle-invasive bladder cancer (NMIBC).
Patients with NMIBC treated with intravesical BCG over a 5-year period were identified. The correlations between histopathological results and disease recurrence and progression were assessed, with survival analysis performed using the Kaplan-Meier method. Other relevant variables were also evaluated using univariate and multivariate analysis. A log-rank test was performed to compare time-to-event between groups.
A total of 215 patients were treated with BCG for NMIBC and the median follow-up was 32 months. Granuloma was identified in 60 patients and inflammation in 125 patients. In 18 patients there was no evidence of either (normal histology group). A total of 12 patients did not have biopsies and were subsequently excluded. The mean recurrence-free survival rate was significantly higher in the granuloma and inflammation groups (65 months [95% CI: 58-72] and 56 months [95% CI: 49-63], respectively) than in the normal histology group (20 months [95% CI: 6-34]; log-rank P < 0.001). On the multivariate analysis, the absence of inflammation/granuloma was significantly associated with recurrence (log-rank P < 0.001). The progression-free survival rate was higher in the granuloma and inflammation groups (75 months [95% CI: 71-79] and 82 months [95% CI: 78-86], respectively) compared with the normal histology group (33 months [95% CI: 17-48]; log-rank P < 0.001). On multivariate analysis, the absence of inflammation/granuloma was significantly associated with recurrence (log-rank P < 0.001).
Inflammation or granuloma in histology samples after intravesical BCG treatment for NMIBC are positive markers of response and their absence increases the risk of recurrence and progression.
评估膀胱癌（BCG）治疗后炎症或肉芽肿对非肌肉浸润性膀胱癌（NMIBC）的预后价值。
确定了 5 年内接受膀胱内 BCG 治疗的 NMIBC 患者。评估了组织病理学结果与疾病复发和进展的相关性，并使用 Kaplan-Meier 方法进行生存分析。还使用单变量和多变量分析评估了其他相关变量。使用对数秩检验比较组间的时间事件。
共 215 例 NMIBC 患者接受 BCG 治疗，中位随访 32 个月。60 例患者有肉芽肿，125 例患者有炎症。18 例患者无任何炎症或肉芽肿（正常组织学组）。12 例患者未进行活检，随后被排除。肉芽肿和炎症组的无复发生存率明显高于正常组织学组（65 个月[95%CI：58-72]和 56 个月[95%CI：49-63]）（log-rank P<0.001）。多变量分析显示，无炎症/肉芽肿与复发显著相关（log-rank P<0.001）。肉芽肿和炎症组的无进展生存率高于正常组织学组（75 个月[95%CI：71-79]和 82 个月[95%CI：78-86]）（log-rank P<0.001）。多变量分析显示，无炎症/肉芽肿与复发显著相关（log-rank P<0.001）。
膀胱内 BCG 治疗 NMIBC 后组织学样本中的炎症或肉芽肿是反应的阳性标志物，其缺失增加了复发和进展的风险。
