Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Urol Oncol. 2020 Oct;38(10):795.e9-795.e17. doi: 10.1016/j.urolonc.2020.04.023. Epub 2020 May 14.
To validate the substratification of high-risk in the European Association of Urology (EAU) guidelines and to develop the simplified substratification to improve usefulness and predictive accuracy on oncological outcomes in patients with primary high-risk nonmuscle-invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumor (TURBT).
We retrospectively evaluated 428 patients with primary high-risk NMIBC who underwent TURBT from November 1993 to April 2019. First, the efficacy of the EAU highest-risk on intravesical recurrence-free survival (RFS) and muscle-invasive bladder cancer (MIBC)-free survival was evaluated with univariate analyses. Second, we developed our simplified substratification based on multivariate analysis for intravesical RFS (lower- and higher-risk). We compared predictive accuracy on oncological outcomes using the receiver operating characteristic curve between the EAU and the simplified substratifications.
Median age and median follow-up periods were 72 years and 51 months, respectively. The EAU highest-risk was not associated with shorter intravesical RFS and MIBC-free survival (P = 0.054 and P = 0.350, respectively). In multivariate analysis, tumor size, grade 3, and chronic kidney disease were significantly associated with shorter intravesical RFS, and we developed the simplified substratification including those 3 factors. Of 428 patients, 89 (21%) were substratified into the simplified higher-risk. The predictive accuracy of the simplified substratification on intravesical recurrence, MIBC and metastasis progression, and cancer-specific mortality was significantly superior to the EAU substratification.
Our simplified substratification might contribute to improving predictive accuracy on intravesical recurrence, MIBC and metastasis progression, and cancer-specific mortality in patients with primary high-risk NMIBC who underwent TURBT.
验证欧洲泌尿外科学会（EAU）指南中的高危分层，并制定简化分层，以提高经尿道膀胱肿瘤切除术（TURBT）治疗初发高危非肌层浸润性膀胱癌（NMIBC）患者的肿瘤学结局的有用性和预测准确性。
我们回顾性评估了 1993 年 11 月至 2019 年 4 月期间接受 TURBT 的 428 例初发高危 NMIBC 患者。首先，通过单因素分析评估 EAU 最高危对膀胱内无复发生存（RFS）和肌层浸润性膀胱癌（MIBC）无复发生存的疗效。其次，我们基于多变量分析为膀胱内 RFS（低危和高危）制定了我们的简化分层。我们通过受试者工作特征曲线比较了 EAU 和简化分层在肿瘤学结局预测准确性方面的差异。
中位年龄和中位随访时间分别为 72 岁和 51 个月。EAU 最高危与较短的膀胱内 RFS 和 MIBC 无复发生存无关（P=0.054 和 P=0.350）。多变量分析显示，肿瘤大小、G3 和慢性肾脏病与较短的膀胱内 RFS 显著相关，我们据此制定了包含这 3 个因素的简化分层。在 428 例患者中，89 例（21%）被分层为简化高危。简化分层对膀胱内复发、MIBC 和转移进展以及癌症特异性死亡率的预测准确性明显优于 EAU 分层。
我们的简化分层可能有助于提高接受 TURBT 治疗的初发高危 NMIBC 患者的膀胱内复发、MIBC 和转移进展以及癌症特异性死亡率的预测准确性。
