肌层浸润性膀胱癌患者根治性膀胱切除术后风险分层监测及随访的成本效益
Risk-stratified surveillance and cost effectiveness of follow-up after radical cystectomy in patients with muscle-invasive bladder cancer.
作者信息
Kusaka Ayumu, Hatakeyama Shingo, Hosogoe Shogo, Hamano Itsuto, Iwamura Hiromichi, Fujita Naoki, Fukushi Ken, Narita Takuma, Hagiwara Kazuhisa, Yamamoto Hayato, Tobisawa Yuki, Yoneyama Tohru, Yoneyama Takahiro, Hashimoto Yasuhiro, Koie Takuya, Ito Hiroyuki, Yoshikawa Kazuaki, Kawaguchi Toshiaki, Ohyama Chikara
机构信息
Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
出版信息
Oncotarget. 2017 Jul 6;8(39):65492-65505. doi: 10.18632/oncotarget.19043. eCollection 2017 Sep 12.
BACKGROUND
The recurrence risk stratification and the cost effectiveness of oncological surveillance after radical cystectomy are not clear. We aimed to develop a risk stratification and a surveillance protocol with improved cost effectiveness after radical cystectomy.
RESULTS
Of 581 enrolled patients, 175 experienced disease recurrences. The pathology-based protocol presented significant differences in recurrence-free survival between normal- and high-risk patients, but the medical expense was high, especially in normal-risk (≤pT2pN0) patients. Cox regression analysis identified six factors associated with recurrence-free survival. Risk score-based 5-year follow-up was significantly more cost effective than the pathology-based protocol.
MATERIALS AND METHODS
We retrospectively evaluated 581 patients with radical cystectomy for muscle-invasive bladder cancer at 4 hospitals. Patients with routine oncological follow-up were stratified into normal- and high-risk groups by a pathology-based protocol utilizing pT, pN, lymphovascular invasion, and histology. Cost effectiveness of the pathology-based protocol was evaluated and a risk-score-based protocol was developed to optimize cost effectiveness. Risk-scores were calculated by summing risk factors independently associated with recurrence-free survival. Patients were stratified by low-, intermediate-, and high-risk score. Estimated cost per one recurrence detection by the pathology and by risk-scores were compared.
CONCLUSIONS
Risk-score-stratified surveillance protocol has potential to reduce over-evaluation after radical cystectomy without adverse effects on medical cost.
背景
根治性膀胱切除术后复发风险分层及肿瘤监测的成本效益尚不清楚。我们旨在制定一种根治性膀胱切除术后具有更高成本效益的风险分层和监测方案。
结果
在581例入组患者中，175例出现疾病复发。基于病理的方案在低风险和高风险患者的无复发生存率上存在显著差异，但医疗费用较高，尤其是在低风险（≤pT2pN0）患者中。Cox回归分析确定了六个与无复发生存率相关的因素。基于风险评分的5年随访在成本效益上显著优于基于病理的方案。
材料与方法
我们回顾性评估了4家医院581例行根治性膀胱切除术的肌层浸润性膀胱癌患者。通过基于病理的方案，利用pT、pN、淋巴管浸润和组织学，将接受常规肿瘤学随访的患者分为低风险和高风险组。评估基于病理的方案的成本效益，并制定基于风险评分的方案以优化成本效益。通过将与无复发生存率独立相关的风险因素相加来计算风险评分。患者按低、中、高风险评分分层。比较基于病理和基于风险评分的每次复发检测的估计成本。
结论
基于风险评分分层的监测方案有可能减少根治性膀胱切除术后的过度评估，且对医疗成本无不利影响。
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