Gotto Geoffrey T, Shea-Budgell Melissa A, Dean Ruether J
Department of Surgery, Cumming School of Medicine, University of Calgary, Southern Alberta Institute of Urology, Calgary, AB, Canada;
Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada;; Cancer Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada.
Can Urol Assoc J. 2016 Jan-Feb;10(1-2):33-8. doi: 10.5489/cuaj.3143.
Despite high-level evidence of benefit, early repeat resection (ERR) among high-grade T1 bladder cancer (HGT1-BC) patients remains low in several non-Canadian jurisdictions and rates in Canada are largely unreported. We evaluated rates of ERR and trends over time in Alberta. We also examined factors associated with uptake of ERR.
We conducted a retrospective review of data from all patients diagnosed with HGT1-BC from 2007 through 2011. Patients were identified from the Alberta Cancer Registry. Patients with a non-urothelial carcinoma of the bladder and those with invasion into the prostate or metastatic disease were excluded. We collected demographic and clinicopathologic information from patients' electronic medical records.
A total of 600 patients diagnosed with HGT1-BC were included. Overall, 167 patients (27.8%) received an ERR; however, the rate increased in a non-linear fashion from 27.4% in 2007 to 37.8% in 2011. Factors associated with ERR included age <80 years (p=0.021) and centre at which the initial transurethral resection of bladder tumour (TURBT) was performed (p=0.013). Median overall survival (OS) was not reached, but five-year OS was 72.7% (95% CI 68.9, 76.5) for those who received an ERR and 55.3% (95% CI 52.5, 58.1) for those who did not.
Use of ERR in patients with HGT1-BC is improving over time. Regional variation in practice suggests the need for implementation strategies (i.e., provincial clinical care pathways) to standardize practice and set indicators for future measurement and reporting. Targeted interventions would require further investigation around the reasons for variation in practice.
尽管有高级别证据表明其益处，但在几个非加拿大辖区，高级别T1期膀胱癌（HGT1-BC）患者的早期重复切除术（ERR）比例仍然较低，加拿大的相关比例在很大程度上未被报告。我们评估了艾伯塔省ERR的比例及随时间的变化趋势。我们还研究了与ERR采用相关的因素。
我们对2007年至2011年期间所有诊断为HGT1-BC的患者的数据进行了回顾性分析。患者从艾伯塔癌症登记处识别。排除膀胱非尿路上皮癌患者以及侵犯前列腺或有转移性疾病的患者。我们从患者的电子病历中收集了人口统计学和临床病理信息。
总共纳入了600例诊断为HGT1-BC的患者。总体而言，167例患者（27.8%）接受了ERR；然而，该比例以非线性方式从2007年的27.4%增加到2011年的37.8%。与ERR相关的因素包括年龄<80岁（p=0.021）以及首次膀胱肿瘤经尿道切除术（TURBT）实施的中心（p=0.013）。总体生存（OS）中位数未达到，但接受ERR的患者五年OS为72.7%（95%CI 68.9, 76.5），未接受ERR的患者为55.3%（95%CI 52.5, 58.1）。
随着时间的推移，HGT1-BC患者中ERR的使用情况正在改善。实践中的地区差异表明需要实施策略（即省级临床护理路径）来规范实践并设定未来测量和报告的指标。针对性干预将需要围绕实践差异的原因进行进一步调查。
