Ferro Matteo, Vartolomei Mihai Dorin, Cantiello Francesco, Lucarelli Giuseppe, Di Stasi Savino M, Hurle Rodolfo, Guazzoni Giorgio, Busetto Gian Maria, De Berardinis Ettore, Damiano Rocco, Perdonà Sisto, Borghesi Marco, Schiavina Riccardo, Almeida Gilberto L, Bove Pierluigi, Lima Estevao, Grimaldi Giovanni, Autorino Riccardo, Crisan Nicolae, Abu Farhan Abdal Rahman, Verze Paolo, Battaglia Michele, Serretta Vincenzo, Russo Giorgio Ivan, Morgia Giuseppe, Musi Gennaro, de Cobelli Ottavio, Mirone Vincenzo, Shariat Shahrokh F
Division of Urology, European Institute of Oncology, Milan, Italy.
Department of Urology, Medical University of Vienna, Vienna, Austria.
Urol Int. 2018;101(1):7-15. doi: 10.1159/000490765. Epub 2018 Jul 4.
The aim of this multicenter study was to investigate the prognostic impact of residual T1 high-grade (HG)/G3 tumors at re-transurethral resection (TUR of bladder tumor) in a large multi-institutional cohort of patients with primary T1 HG/G3 bladder cancer (BC).
The study period was from January 2002 to -December 2012. A total of 1,046 patients with primary T1 HG/G3 and who had non-muscle invasive BC (NMIBC) on re-TUR followed by adjuvant intravesical Bacillus Calmette-Guerin (BCG) therapy with maintenance were included. Endpoints were time to disease recurrence, progression, and overall and cancer-specific death.
A total of 257 (24.6%) patients had residual T1 HG/G3 tumors. The presence of concomitant carcinoma in situ, multiple and large tumors (> 3 cm) at first TUR were associated with residual T1 HG/G3. Five-year recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) were 17% (CI 11.8-23); 58.2% (CI 50.7-65); 73.7% (CI 66.3-79.7); and 84.5% (CI 77.8-89.3), respectively, in patients with residual T1 HG/G3, compared to 36.7% (CI 32.8-40.6); 71.4% (CI 67.3-75.2); 89.8% (CI 86.6-92.3); and 95.7% (CI 93.4-97.3), respectively, in patients with NMIBC other than T1 HG/G3 or T0 tumors. Residual T1 HG/G3 was independently associated with RFS, PFS, OS, and CSS in multivariable analyses.
Residual T1 HG/G3 tumor at re-TUR confers worse prognosis in patients with primary T1 HG/G3 treated with maintenance BCG. Patients with residual T1 HG/G3 for primary T1 HG/G3 are very likely to fail BCG therapy alone.
本多中心研究的目的是在一个大型多机构队列的原发性T1高级别（HG）/G3膀胱癌（BC）患者中，调查再次经尿道膀胱肿瘤切除术（TURBT）时残留的T1高级别/HG3肿瘤的预后影响。
研究期间为2002年1月至2012年12月。共有1046例原发性T1 HG/G3且再次TURBT后诊断为非肌层浸润性膀胱癌（NMIBC）并接受辅助膀胱内卡介苗（BCG）维持治疗的患者纳入研究。观察终点为疾病复发时间、进展时间、总生存时间和癌症特异性死亡时间。
共有257例（24.6%）患者存在残留的T1 HG/G3肿瘤。初次TURBT时伴有原位癌、多发及大肿瘤（>3 cm）与残留T1 HG/G3相关。残留T1 HG/G3患者的5年无复发生存率（RFS）、无进展生存率（PFS）、总生存率（OS）和癌症特异性生存率（CSS）分别为17%（95%CI 11.8-23）；58.2%（95%CI 50.7-65）；73.7%（95%CI 66.3-79.7）；和84.5%（95%CI 77.8-89.3），而T1 HG/G3或T0以外的NMIBC患者相应指标分别为36.7%（95%CI 32.8-40.6）；71.4%（95%CI 67.3-75.2）；89.8%（95%CI 86.6-92.3）；和95.7%（95%CI 93.4-97.3）。多变量分析显示，残留T1 HG/G3与RFS、PFS、OS和CSS独立相关。
再次TURBT时残留的T1 HG/G3肿瘤会使接受BCG维持治疗的原发性T1 HG/G3患者预后更差。原发性T1 HG/G3患者残留T1 HG/G3很可能单独接受BCG治疗失败。
