Orsola A, Werner L, de Torres I, Martin-Doyle W, Raventos C X, Lozano F, Mullane S A, Leow J J, Barletta J A, Bellmunt J, Morote J
Department of Oncology, Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA 02215, USA.
Departments of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.
Br J Cancer. 2015 Feb 3;112(3):468-74. doi: 10.1038/bjc.2014.633. Epub 2014 Dec 23.
Management of high-grade T1 (HGT1) bladder cancer represents a major challenge. We studied a treatment strategy according to substaging by depth of lamina propria invasion.
In this prospective observational cohort study, patients received initial transurethral resection (TUR), mitomycin-C, and BCG. Subjects with shallower lamina propria invasion (HGT1a) were followed without further surgery, whereas subjects with HGT1b received a second TUR. Association of clinical and histological features with outcomes (primary: progression; secondary: recurrence and cancer-specific survival) was assessed using Cox regression.
Median age was 71 years; 89.5% were males, with 89 (44.5%) cases T1a and 111 (55.5%) T1b. At median follow-up of 71 months, disease progression was observed in 31 (15.5%) and in univariate analysis, substaging, carcinoma in situ, tumour size, and tumour pattern predicted progression. On multivariate analysis only substaging, associated carcinoma in situ, and tumour size remained significant for progression.
In HGT1 bladder cancer, the strategy of performing a second TUR only in T1b cases results in a global low progression rate of 15.5%. Tumours deeply invading the lamina propria (HGT1b) showed a three-fold increase in risk of progression. Substaging should be routinely evaluated, with HGT1b cases being thoroughly evaluated for cystectomy. Inclusion in the TNM system should also be carefully considered.
高级别T1期（HGT1）膀胱癌的管理是一项重大挑战。我们根据固有层浸润深度进行亚分期研究了一种治疗策略。
在这项前瞻性观察性队列研究中，患者接受了初始经尿道切除术（TUR）、丝裂霉素-C和卡介苗。固有层浸润较浅（HGT1a）的受试者无需进一步手术进行随访，而HGT1b的受试者接受第二次TUR。使用Cox回归评估临床和组织学特征与结局（主要结局：进展；次要结局：复发和癌症特异性生存）之间的关联。
中位年龄为71岁；89.5%为男性，其中89例（44.5%）为T1a期，111例（55.5%）为T1b期。在中位随访71个月时，31例（15.5%）观察到疾病进展，单因素分析显示，亚分期、原位癌、肿瘤大小和肿瘤模式可预测进展。多因素分析显示，只有亚分期、相关原位癌和肿瘤大小对进展仍具有显著意义。
在HGT1膀胱癌中，仅对T1b期病例进行第二次TUR的策略导致总体低进展率为15.5%。深度浸润固有层的肿瘤（HGT1b）进展风险增加了两倍。应常规评估亚分期，对HGT1b期病例进行膀胱切除术的全面评估。纳入TNM系统也应仔细考虑。
