Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
Department of Urology, Tama-Nambu Chiiki Hospital, Tokyo, Japan.
Clin Genitourin Cancer. 2020 Apr;18(2):e62-e70. doi: 10.1016/j.clgc.2019.10.005. Epub 2019 Oct 16.
Tumor location in bladder neck has reported to be a prognostic factor for non-muscle-invasive bladder cancer (NMIBC). We investigated the impact of bladder neck involvement (BNI) on recurrence in NMIBC using time-dependent covariate analysis.
We enrolled 585 Japanese patients who underwent transurethral resection for bladder tumors at a single center from 2000 to 2016 and were pathologically diagnosed with Ta and T1 NMIBC. Each patient at each recurrence was assigned to a separate time-dependent stratum with its own baseline hazard function according to the Prentice-Williams-Peterson gap time model for analyzing recurrent events.
Over a median follow-up period of 41.3 months (interquartile range, 18.0-82.3 months), 253 (43.2%) patients experienced a total of 475 recurrences. Among the 1001 total transurethral resection procedures, BNI was observed in 122 (12.2%) cases. The 3-year cumulative recurrence rates of patients with and without BNI were 62.5% and 46.3%, respectively. Multivariable analysis revealed that number of tumors ≥ 4 (sub-hazard ratio [SHR], 1.48; P = .004), intravesical bacillus Calmette-Guérin therapy (SHR, 0.44; P < .001), and BNI (SHR, 1.59; P = .004) were all independent predictors of recurrence. Assigning 1 point for each of these 3 predictive factors, the resulting scores enabled us to classify patients into 3 prognostic groups that were clearly stratified according to recurrence.
Our time-dependent covariate analysis shows that BNI is a significant risk factor for recurrence in NMIBC. Our prognostic model incorporating BNI is an easy means of estimating recurrence risk and determining optimal management for individual patients.
膀胱颈部肿瘤位置被报道为非肌肉浸润性膀胱癌（NMIBC）的预后因素。我们通过时间依赖性协变量分析研究了膀胱颈部受累（BNI）对 NMIBC 复发的影响。
我们招募了 585 名 2000 年至 2016 年在一家中心接受经尿道膀胱肿瘤切除术的日本患者，这些患者经病理诊断为 Ta 和 T1 NMIBC。根据分析复发性事件的 Prentice-Williams-Peterson 间隙时间模型，每位患者在每次复发时都被分配到一个单独的时间依赖性分层，该分层具有自己的基线风险函数。
在中位随访 41.3 个月（四分位间距，18.0-82.3 个月）期间，253 名（43.2%）患者共发生 475 次复发。在总共 1001 次经尿道切除术程序中，观察到 122 例（12.2%）存在 BNI。有和没有 BNI 的患者 3 年累积复发率分别为 62.5%和 46.3%。多变量分析显示肿瘤数量≥4（亚危险比 [SHR]，1.48；P=0.004）、膀胱内卡介苗治疗（SHR，0.44；P<0.001）和 BNI（SHR，1.59；P=0.004）都是复发的独立预测因素。将这 3 个预测因素中的每个因素赋值 1 分，所得分数使我们能够将患者分为 3 个预后组，这些组根据复发情况进行了明确分层。
我们的时间依赖性协变量分析表明，BNI 是 NMIBC 复发的重要危险因素。我们的包含 BNI 的预后模型是一种简单的方法，可以估计复发风险并为个体患者确定最佳治疗方案。
