Schubert Tina, Danzig Matthew R, Kotamarti Srinath, Ghandour Rashed A, Lascano Danny, Dubow Byron P, Decastro G Joel, Benson Mitchell C, McKiernan James M
Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, Herbert Irving Pavilion 11th Floor, New York, NY, 10032, USA.
World J Urol. 2015 Jun;33(6):847-52. doi: 10.1007/s00345-014-1383-5. Epub 2014 Aug 23.
To determine whether heterogeneity of tumor grade affects the response to Bacillus Calmette-Guérin (BCG) treatment for patients with non-muscle-invasive bladder cancer (NMIBC).
Patients with Ta or T1 NMBIC receiving a 6-week induction course of intravesical BCG therapy after transurethral resection were divided according to the tumor grade. Clinical and pathological variables were compared. Advanced intervention-free survival (AIFS), defined as duration of freedom from advanced intervention (including non-BCG intravesical agents or cystectomy) or metastasis, was plotted using Kaplan-Meier methods. The effect of grade on survival duration was assessed by multivariate Cox proportional hazards modeling.
One hundred and fifty-three patients were identified: 17 with mixed low- and high-grade (MG) and 136 with pure high-grade (PHG) NMIBC. Demographic and additional pathologic variables were comparable between groups (p > 0.05). Five-year AIFS was 88.2% for MG patients, compared to 48.5% for PHG patients (p = 0.030 by log-rank test). On multivariate analysis, PHG was an independent risk factor for worse AIFS (HR 4.4, 95% CI 1.1-18.4, p = 0.040). Among patients failing to respond to primary BCG induction, who underwent a secondary induction of BCG with interferon, MG patients had better response than PHG patients (100 vs. 26.3%, p = 0.035).
Mixed low- and high-grade NMIBC exhibits a significantly better response profile to intravesical BCG therapy compared to PHG NMIBC. The implications of these results are that less aggressive treatment strategies for this unique cancer entity may be needed and that there is a benefit to the reporting of tumor heterogeneity in transurethral resection of bladder tumor specimens.
确定肿瘤分级的异质性是否会影响非肌层浸润性膀胱癌（NMIBC）患者对卡介苗（BCG）治疗的反应。
经尿道切除术后接受为期6周膀胱内BCG诱导治疗的Ta或T1期NMBIC患者，根据肿瘤分级进行分组。比较临床和病理变量。使用Kaplan-Meier方法绘制无进展生存期（AIFS），即无进展干预（包括非BCG膀胱内药物或膀胱切除术）或转移的持续时间。通过多变量Cox比例风险模型评估分级对生存持续时间的影响。
共纳入153例患者：17例为低级别和高级别混合（MG）的NMIBC患者，136例为纯高级别（PHG）的NMIBC患者。两组间的人口统计学和其他病理变量具有可比性（p>0.05）。MG患者的5年AIFS为88.2%，而PHG患者为48.5%（对数秩检验p=0.030）。多变量分析显示，PHG是AIFS较差的独立危险因素（HR 4.4，95%CI 1.1-18.4，p=0.040）。在对初始BCG诱导治疗无反应并接受BCG联合干扰素二次诱导治疗的患者中，MG患者的反应优于PHG患者（100%对26.3%，p=0.035）。
与PHG NMIBC相比，低级别和高级别混合的NMIBC对膀胱内BCG治疗的反应明显更好。这些结果表明，对于这种独特的癌症实体，可能需要采用侵入性较小的治疗策略，并且在膀胱肿瘤标本的经尿道切除术中报告肿瘤异质性是有益的。
