未经治疗的肌肉浸润性膀胱癌的自然史。

The natural history of untreated muscle-invasive bladder cancer.

机构信息

Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.

出版信息

BJU Int. 2020 Feb;125(2):270-275. doi: 10.1111/bju.14872. Epub 2019 Aug 7.

DOI:10.1111/bju.14872

PMID:31310696

Abstract

OBJECTIVE

To describe the natural history of untreated muscle-invasive bladder cancer (MIBC) and compare the oncological outcomes of treated and untreated patients.

PATIENTS AND METHODS

We utilised a database encompassing all patients with newly diagnosed bladder cancer in Stockholm, Sweden between 1995 and 1996. The median follow-up for survivors was 14.4 years. Overall, 538 patients were diagnosed with bladder cancer of whom 126 had clinically localised MIBC. Patients were divided into two groups: those who received radical cystectomy or radiation therapy, and those who did not receive any form of treatment. Multivariable Cox or competing-risks regressions were adopted to predict metastasis, overall survival (OS), and cancer-specific mortality (CSM), when appropriate. Analyses were adjusted for age at diagnosis, sex, tumour stage, clinical N stage, and treatment.

RESULTS

In all, 64 (51%) patients did not receive any definitive local treatment. In the untreated group, the median (interquartile range) age at diagnosis was 79 (63-83) vs 69 (63-74) years in the treated group (P < 0.001). Overall, 109 patients died during follow-up. At 6 months after diagnosis, 38% of the untreated patients had developed metastatic disease and 41% had CSM. The 5-year OS rate for untreated and treated patients was 5% (95% confidence interval [CI] 1, 12%) vs 48% (95% CI 36, 60%), respectively. Patients not receiving any treatment had a 5-year cumulative incidence of CSM of 86% (95% CI 75, 94%) vs 48% (95% CI 36, 60%) for treated patients. Untreated patients had a higher risk of progression to metastatic disease (hazard ratio [HR] 2.40, 95% CI 1.28, 4.51; P = 0.006), death from any cause (HR 2.63, 95% CI 1.65, 4.19; P < 0.001) and CSM (subdistribution HR 2.02, 95% CI 1.24, 3.30; P = 0.004).

CONCLUSIONS

Untreated patients with MIBC are at very high risk of near-term CSM. These findings may help balance the risks vs benefits of integrating curative intent therapy particularly in older patients with MIBC.

摘要

目的

描述未经治疗的肌层浸润性膀胱癌（MIBC）的自然病程，并比较治疗和未治疗患者的肿瘤学结局。

患者和方法

我们利用了一个包含 1995 年至 1996 年期间在瑞典斯德哥尔摩新诊断膀胱癌的所有患者的数据库。幸存者的中位随访时间为 14.4 年。共有 538 名患者被诊断为膀胱癌，其中 126 名患者患有临床局限性 MIBC。患者分为两组：接受根治性膀胱切除术或放疗的患者，以及未接受任何形式治疗的患者。采用多变量 Cox 或竞争风险回归来预测转移、总生存（OS）和癌症特异性死亡率（CSM），必要时进行分析。分析根据诊断时的年龄、性别、肿瘤分期、临床 N 分期和治疗进行调整。

结果

共有 64 名（51%）患者未接受任何确定性局部治疗。在未治疗组中，中位（四分位距）诊断时年龄为 79（63-83）岁，而治疗组为 69（63-74）岁（P<0.001）。总的来说，109 名患者在随访期间死亡。在诊断后 6 个月时，38%的未治疗患者出现转移性疾病，41%出现 CSM。未治疗和治疗患者的 5 年 OS 率分别为 5%（95%CI 1%，12%）和 48%（95%CI 36%，60%）。未接受任何治疗的患者 5 年 CSM 的累积发生率为 86%（95%CI 75%，94%），而治疗组为 48%（95%CI 36%，60%）。未治疗的患者发生进展为转移性疾病的风险更高（风险比 [HR] 2.40，95%CI 1.28，4.51；P=0.006），死于任何原因的风险（HR 2.63，95%CI 1.65，4.19；P<0.001）和 CSM（亚分布 HR 2.02，95%CI 1.24，3.30；P=0.004）。