D Andrea David, Abufaraj Mohammad, Susani Martin, Ristl Robin, Foerster Beat, Kimura Shoji, Mari Andrea, Soria Francesco, Briganti Alberto, Karakiewicz Pierre I, Gust Killian M, Rouprêt Morgan, Shariat Shahrokh F
Department of Urology, Medical University of Vienna, Vienna, Austria.
Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
Urol Oncol. 2018 May;36(5):239.e1-239.e7. doi: 10.1016/j.urolonc.2018.01.018. Epub 2018 Mar 3.
To improve current prognostic models for the selection of patients with T1G3 urothelial bladder cancer who are more likely to fail intravesical therapy and progress to muscle-invasive bladder cancer (MIBC).
We performed a retrospective analysis of 1,289 patients with pT1G3 urothelial bladder cancer who were treated with transurethral resection of the bladder (TURB) and adjuvant intravesical bacillus-Calmette-Guérin (BCG). Random-split sample data and competing-risk regression were used to identify the independent impact of lymphovascular invasion (LVI) and variant histology (VH) on progression to MIBC. We developed a nomogram for predicting patient-specific probability of disease progression at 2 and 5 years after TURB. Decision curve analysis (DCA) was performed to evaluate the clinical benefit associated with the use of our nomogram.
In the development cohort, within a median follow-up of 51.6 months (IQR: 19.3-92.5), disease progression occurred in 89 patients (13.8%). A total of 84 (13%) patients were found to have VH and 57 (8.8%) with LVI at TURB. Both factors were independently associated with disease progression on multivariable competing-risk analysis (HR: 4.4; 95% CI: 2.8-6.9; P<0.001 and HR: 3.5; 95% CI: 2.1-5.8; P<0.001, respectively). DCA showed superior net benefits for the nomogram within a threshold probability of progression between 5% and 55%. Limitations are inherent to the retrospective design.
We demonstrated the clinical value of the integration of LVI and VH in a prognostic model for the prediction of MIBC. Indeed, our tool provides superior individualized risk estimation of progression facilitating decision-making regarding early RC.
改进当前的预后模型，以筛选出更有可能膀胱内治疗失败并进展为肌层浸润性膀胱癌（MIBC）的T1G3尿路上皮膀胱癌患者。
我们对1289例接受经尿道膀胱肿瘤切除术（TURB）及辅助膀胱内卡介苗（BCG）治疗的pT1G3尿路上皮膀胱癌患者进行了回顾性分析。采用随机分割样本数据和竞争风险回归分析，以确定淋巴管浸润（LVI）和组织学变异（VH）对进展为MIBC的独立影响。我们构建了一个列线图，用于预测TURB术后2年和5年患者疾病进展的个体概率。进行决策曲线分析（DCA）以评估使用我们的列线图的临床获益。
在开发队列中，中位随访时间为51.6个月（四分位间距：19.3 - 92.5），89例患者（13.8%）出现疾病进展。TURB时共发现84例（13%）患者存在VH，57例（8.8%）存在LVI。多变量竞争风险分析显示，这两个因素均与疾病进展独立相关（HR分别为：4.4；95%CI：2.8 - 6.9；P<0.001和HR：3.5；95%CI：2.1 - 5.8；P<0.001）。DCA显示，在进展概率阈值为5%至55%时，列线图具有更高的净获益。本研究存在回顾性设计固有的局限性。
我们证明了将LVI和VH纳入预测MIBC的预后模型中的临床价值。实际上，我们的工具提供了更高的个体化进展风险估计，有助于关于早期根治性膀胱切除术的决策制定。
