Department of Urology, University of Miami Miller School of Medicine, Miami, Florida.
Sylvester Comprehensive Cancer Center, Miami, Florida.
J Urol. 2020 Mar;203(3):505-511. doi: 10.1097/JU.0000000000000593. Epub 2019 Oct 14.
We applied nonmuscle invasive bladder cancer AUA (American Urological Association)/SUO (Society of Urologic Oncology) guidelines for risk stratification and analyzed predictors of recurrence and progression.
We retrospectively reviewed the records of 398 patients with nonmuscle invasive bladder cancer treated between 2001 and 2017. Descriptive statistics were used to compare AUA/SUO risk groups. Predictors of recurrence and progression were determined by multivariable regression. Kaplan-Meier analysis was done, a Cox proportional hazards regression model was created and time dependent AUCs were calculated to determine progression-free and recurrence-free survival by risk group.
Median followup was 37 months (95% CI 35-42). Of the patients 92% underwent bacillus Calmette-Guérin induction and 46% received at least 1 course of maintenance treatment. Of the patients 11.5% were at low, 32.5% were at intermediate and 55.8% were at high risk. In patients at low, intermediate and high risk the 5-year progression-free survival rate was 93%, 74% and 54%, and the 5-year recurrence-free survival rate was 43%, 33% and 23%, respectively. Kaplan-Meier analysis was done to stratify high grade Ta 3 cm or less tumor recurrence-free and progression-free survival in the intermediate vs the high risk group. Relative to low risk, classification as intermediate and as high risk was an independent predictor of progression (HR 9.7, 95% CI 2.23-42.0, p <0.01, and HR 36, 95% CI 8.16-159, p <0.001, respectively). Recurrence was more likely in patients at high risk than in those at low risk (HR 2.03, 95% CI 1.11-3.71, p=0.022). For recurrence and progression the 1-year AUC was 0.60 (95% CI 0.546-0.656) and 0.68 (95% CI 0.622-0.732), respectively.
The AUA/SUO nonmuscle invasive bladder cancer risk classification system appropriately stratifies patients based on the likelihood of recurrence and progression. It should be used at diagnosis to counsel patients and guide therapy.
我们应用非肌肉浸润性膀胱癌 AUA（美国泌尿外科学会）/SUO（泌尿肿瘤学会）风险分层指南，并分析复发和进展的预测因素。
我们回顾性分析了 2001 年至 2017 年间治疗的 398 例非肌肉浸润性膀胱癌患者的病历。采用描述性统计方法比较 AUA/SUO 风险组。采用多变量回归分析确定复发和进展的预测因素。采用 Kaplan-Meier 分析、Cox 比例风险回归模型，并计算时间依赖性 AUC，以确定按风险组划分的无进展和无复发生存率。
中位随访时间为 37 个月（95%CI 35-42）。92%的患者接受了卡介苗诱导治疗，46%的患者接受了至少 1 个疗程的维持治疗。11.5%的患者为低危，32.5%的患者为中危，55.8%的患者为高危。低危、中危和高危患者的 5 年无进展生存率分别为 93%、74%和 54%，5 年无复发生存率分别为 43%、33%和 23%。Kaplan-Meier 分析用于分层中危与高危患者的高级 Ta3cm 或更小肿瘤的无复发生存率和无进展生存率。与低危相比，中危和高危分类是进展的独立预测因素（HR 9.7，95%CI 2.23-42.0，p<0.01，和 HR 36，95%CI 8.16-159，p<0.001）。高危患者比低危患者更有可能复发（HR 2.03，95%CI 1.11-3.71，p=0.022）。对于复发和进展，1 年 AUC 分别为 0.60（95%CI 0.546-0.656）和 0.68（95%CI 0.622-0.732）。
AUA/SUO 非肌肉浸润性膀胱癌风险分层系统根据复发和进展的可能性适当分层患者。它应该在诊断时用于为患者提供咨询并指导治疗。
