Department of Urology, Medical University of Vienna, Vienna, Austria.
Città della Salute e della Scienza di Torino, University of Studies of Turin, Turin, Italy.
World J Urol. 2018 Nov;36(11):1775-1781. doi: 10.1007/s00345-018-2450-0. Epub 2018 Aug 31.
To evaluate the oncological impact of postponing radical cystectomy (RC) to allow further conservative therapies prior to progression in a large multicentre retrospective cohort of T1-HG/G3 patients initially treated with BCG.
According to the time of RC, the population was divided into 3 groups: patients who did not progress to muscle-invasive disease, patients who progressed before radical cystectomy and patients who experienced progression at the time of radical cystectomy. Clinical and pathological outcomes were compared across the three groups.
Of 2451 patients, 509 (20.8%) underwent RC. Patients with tumors > 3 cm or with CIS had earlier cystectomies (HR = 1.79, p = 0.001 and HR = 1.53, p = 0.02, respectively). Patients with tumors > 3 cm, multiple tumors or CIS had earlier T3/T4 or N + cystectomies. In patients who progressed, the timing of cystectomy did not affect the risk of T3/T4 or N + disease at RC. Patients with T3/T4 or N + disease at RC had a shorter disease-specific survival (HR = 4.38, p < 0.001), as did patients with CIS at cystectomy (HR = 2.39, p < 0.001). Patients who progressed prior to cystectomy had a shorter disease-specific survival than patients for whom progression was only detected at cystectomy (HR = 0.58, p = 0.024) CONCLUSIONS: Patients treated with RC before experiencing progression to muscle-invasive disease harbor better oncological and survival outcomes compared to those who progressed before RC and to those upstaged at surgery. Tumor size and concomitant CIS at diagnosis are the main predictors of surgical treatment while tumor size, CIS and tumor multiplicity are associated with extravesical disease at surgery.
评估在经卡介苗（BCG）初始治疗后进展为 T1-HG/G3 患者中，对存在进展风险的患者推迟根治性膀胱切除术（RC）以允许进一步行保守治疗的肿瘤学影响。
根据 RC 的时间，将人群分为 3 组：未进展为肌层浸润性疾病的患者、RC 前进展的患者和 RC 时进展的患者。比较三组的临床和病理结局。
在 2451 例患者中，509 例（20.8%）接受了 RC。肿瘤>3cm 或 CIS 的患者更早行 RC（HR=1.79，p=0.001 和 HR=1.53，p=0.02）。肿瘤>3cm、多个肿瘤或 CIS 的患者更早行 T3/T4 或 N+RC。在进展的患者中，RC 时机不影响 RC 时 T3/T4 或 N+疾病的风险。RC 时患有 T3/T4 或 N+疾病的患者疾病特异性生存率更短（HR=4.38，p<0.001），RC 时患有 CIS 的患者也是如此（HR=2.39，p<0.001）。RC 前进展的患者疾病特异性生存率短于仅在 RC 时发现进展的患者（HR=0.58，p=0.024）。
与 RC 前进展和手术时升级的患者相比，在进展为肌层浸润性疾病之前接受 RC 的患者具有更好的肿瘤学和生存结局。诊断时的肿瘤大小和同时存在 CIS 是手术治疗的主要预测因素，而肿瘤大小、CIS 和肿瘤多发性与手术时的膀胱外疾病相关。
