Department of Urology, Center for Prostate Cancer, Research Institute and Hospital of the National Cancer Center, Goyang, Korea.
Department of Urology, Seoul National University Hospital, Seoul, Korea.
Ann Surg Oncol. 2017 Aug;24(8):2413-2419. doi: 10.1245/s10434-017-5902-7. Epub 2017 May 30.
Several studies have documented a poor prognosis in those patients who were initially diagnosed with non-muscle-invasive bladder cancer (NMBIC) and progressed to muscle-invasive bladder cancer (MIBC) compared with those who initially presented with MIBC. However, studies regarding this issue have not yet been performed in patients with T1 high-grade (T1HG) tumor. We aimed to compare survival outcomes between patients diagnosed as T1HG after initial transurethral resection of the bladder tumor (TUR-BT) and patients who presented with lower stage and/or grade but progressed to T1HG at the time of tumor recurrence.
The study comprised 499 patients who had a diagnosis of T1HG after initial TUR-BT (initial T1HG group) and 62 patients who progressed to T1HG after TUR-BT at the time of tumor recurrence (progressed T1HG group). Progression was defined as recurrence to a higher grade and/or stage than the previous result, while MIBC progression was defined as progression to stage T2 or higher and/or N+, and/or M1.
The median overall survival (OS) and cancer-specific survival (CSS) durations were 38.0 and 29.0 months, respectively. Kaplan-Meier curve analysis showed significantly decreased 5-year OS (74.4 vs. 57.4%), CSS (86.4 vs. 72.8%), and MIBC progression-free survival (82.6 vs. 62.2%) in the progressed T1HG group. Multivariate analysis revealed that progressed T1HG was a significant predictor of OS, CSS, and MIBC progression (all, p < 0.05).
The progressed T1HG group showed poorer survival outcomes compared with the initial T1HG group. Consequently, in patients who progress to T1HG, intensive surveillance and treatment strategies should be considered.
多项研究表明，与初始诊断为肌层浸润性膀胱癌（MIBC）且进展为非肌层浸润性膀胱癌（NMBIC）的患者相比，初始诊断为 NMBIC 且进展为 MIBC 的患者预后较差。然而，针对这一问题的研究尚未在 T1 高分级（T1HG）肿瘤患者中开展。我们旨在比较初始经尿道膀胱肿瘤切除术（TUR-BT）后诊断为 T1HG 的患者与初始分期和/或分级较低但在肿瘤复发时进展为 T1HG 的患者的生存结局。
该研究纳入了 499 例初始 TUR-BT 后诊断为 T1HG 的患者（初始 T1HG 组）和 62 例在 TUR-BT 时肿瘤复发后进展为 T1HG 的患者（进展 T1HG 组）。进展定义为复发时分级和/或分期高于之前的结果，而 MIBC 进展定义为进展至 T2 期或更高分期和/或 N+，和/或 M1。
中位总生存（OS）和癌症特异性生存（CSS）时间分别为 38.0 个月和 29.0 个月。Kaplan-Meier 曲线分析显示，进展 T1HG 组的 5 年 OS（74.4% vs. 57.4%）、CSS（86.4% vs. 72.8%）和 MIBC 无进展生存（82.6% vs. 62.2%）显著降低。多变量分析显示，进展 T1HG 是 OS、CSS 和 MIBC 进展的显著预测因素（均 P<0.05）。
与初始 T1HG 组相比，进展 T1HG 组的生存结局较差。因此，对于进展为 T1HG 的患者，应考虑进行强化监测和治疗策略。
