Department of Urology, Einstein Healthcare Network and Urologic Institute of Southeastern Pennsylvania, PA, USA.
Department of Urology, Emory University and Atlanta Veterans Administration Medical Center, Atlanta, Georgia, USA.
Int Braz J Urol. 2014 Mar-Apr;40(2):172-8. doi: 10.1590/S1677-5538.IBJU.2014.02.06.
High-grade T1 (HGT1) bladder cancer represents a clinical challenge in that the urologist must balance the risk of disease progression against the morbidity and potential mortality of early radical cystectomy and urinary diversion. Using two non-muscle invasive bladder cancer (NMIBC) databases, we re-examined the rate of progression of HG T1 bladder cancer in our bladder cancer populations.
We queried the NMIBC databases that have been established independently at the Atlanta Veterans Affairs Medical Center (AVAMC) and the University of Pennsylvania to identify patients initially diagnosed with HGT1 bladder cancer. Demographic, clinical, and pathologic variables were examined as well as rates of recurrence and progression.
A total of 222 patients were identified; 198 (89.1%) and 199 (89.6%) of whom were male and non-African American, respectively. Mean patient age was 66.5 years. 191 (86.0%) of the patients presented with isolated HG T1 disease while 31 (14.0%) patients presented with HGT1 disease and CIS. Induction BCG was utilized in 175 (78.8%) patients. Recurrence occurred in 112 (50.5%) patients with progression occurring in only 19 (8.6%) patients. At a mean follow-up of 51 months, overall survival was 76.6%. Fifty two patients died, of whom only 13 (25%) patient deaths were bladder cancer related.
In our large cohort of patients, we found that the risk of progression at approximately four years was only 8.6%. While limited by its retrospective nature, this study could potentially serve as a starting point in re-examining the treatment algorithm for patients with HG T1 bladder cancer.
高级别 T1（HGT1）膀胱癌是临床治疗的难点，泌尿科医生必须平衡疾病进展的风险与根治性膀胱切除术和尿流改道的发病率和潜在死亡率。本研究利用两个非肌肉浸润性膀胱癌（NMIBC）数据库，重新分析了膀胱癌患者中 HGT1 膀胱癌的进展率。
我们分别在亚特兰大退伍军人事务医疗中心（AVAMC）和宾夕法尼亚大学建立的 NMIBC 数据库中检索，以确定最初诊断为 HGT1 膀胱癌的患者。检查了人口统计学、临床和病理变量以及复发和进展率。
共鉴定出 222 例患者，其中 198 例（89.1%）和 199 例（89.6%）患者为男性和非非裔美国人，平均患者年龄为 66.5 岁。191 例（86.0%）患者为孤立性 HGT1 疾病，31 例（14.0%）患者为 HGT1 疾病伴 CIS。175 例（78.8%）患者接受了诱导性 BCG。112 例（50.5%）患者出现复发，仅 19 例（8.6%）患者出现进展。在平均随访 51 个月时，总生存率为 76.6%。52 例患者死亡，其中仅 13 例（25%）患者的死亡与膀胱癌相关。
在我们的大型患者队列中，我们发现大约四年时的进展风险仅为 8.6%。虽然受到回顾性研究的限制，但本研究可能为重新检查 HGT1 膀胱癌患者的治疗方案提供了一个起点。
