Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Urology. 2019 Jul;129:74-78. doi: 10.1016/j.urology.2019.04.009. Epub 2019 Apr 18.
To quantify the use of downstream studies following staging bone scans in patients with muscle-invasive bladder cancer. Bone scans may be obtained in high-risk bladder cancer patients prior to radical cystectomy to exclude bone metastases. However, false-positive bone scans can occur, resulting in the need for additional studies.
Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified 4404 patients diagnosed with muscle-invasive bladder cancer from 2004 to 2011. We further identified those who underwent a bone scan prior to treatment within 6 months of diagnosis and prior to any treatment with cystectomy, radiotherapy, or chemotherapy. We determined the proportion of patients who underwent a subsequent study (bone X-ray, bone CT, bone MRI, and/or bone biopsy) within 3 months of the bone scan and prior to treatment.
Among patients diagnosed with muscle-invasive bladder cancer, 1373 (31%) had a staging bone scan of whom 26% received a downstream study (n = 213). Overall, 61 patients (7%) received downstream bone-specific X-rays, more than 141 patients (>17%) received bone-specific CTs, and 28 patients (3%) received bone-specific MRIs. The use of bone biopsy was rare (n < 11; <1%). The total cost of all downstream studies was $103,468. Furthermore, there was a one-month delay in treatment for those who received a downstream study compared to those who did not (P < 0.001).
Use of bone scan in the staging of muscle-invasive bladder cancer often results in the need for additional downstream studies. The delay in treatment and cost burden of downstream studies highlights a potential disadvantage of the routine use of this staging modality.
量化肌层浸润性膀胱癌患者在进行分期骨扫描后的下游研究的应用情况。在根治性膀胱切除术之前，高危膀胱癌患者可能会进行骨扫描以排除骨转移。然而，可能会出现假阳性骨扫描，导致需要进行额外的研究。
利用监测、流行病学和最终结果（SEER）-医疗保险数据，我们确定了 2004 年至 2011 年间诊断为肌层浸润性膀胱癌的 4404 例患者。我们进一步确定了在诊断后 6 个月内且在接受膀胱切除术、放疗或化疗之前进行骨扫描的患者。我们确定了在骨扫描后 3 个月内接受后续研究（骨 X 线、骨 CT、骨 MRI 和/或骨活检）的患者比例，以及在治疗前的比例。
在诊断为肌层浸润性膀胱癌的患者中，有 1373 例（31%）进行了分期骨扫描，其中 26%（n=213）接受了下游研究。总体而言，有 61 例（7%）患者接受了下游骨特异性 X 射线检查，超过 141 例（>17%）患者接受了骨特异性 CT 检查，28 例（3%）患者接受了骨特异性 MRI 检查。骨活检的应用很少（n<11；<1%）。所有下游研究的总费用为 103468 美元。此外，与未接受下游研究的患者相比，接受下游研究的患者治疗时间延迟了一个月（P<0.001）。
在肌层浸润性膀胱癌的分期中使用骨扫描常常导致需要进行额外的下游研究。下游研究的治疗延迟和成本负担凸显了这种分期方式常规应用的潜在劣势。
