慢性肾脏病对高危非肌层浸润性膀胱癌患者行辅助卡介苗治疗后肿瘤学结局的影响。
Impact of chronic kidney disease on oncological outcomes in patients with high-risk non-muscle-invasive bladder cancer who underwent adjuvant bacillus Calmette-Guérin therapy.
机构信息
Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
出版信息
Urol Oncol. 2021 Mar;39(3):191.e9-191.e16. doi: 10.1016/j.urolonc.2020.06.032. Epub 2020 Jul 23.
OBJECTIVES
To investigate the impact of chronic kidney disease (CKD) on oncological outcomes in patients with high-risk non-muscle invasive bladder cancer (NMIBC) who underwent adjuvant induction bacillus Calmette-Guérin (BCG) therapy after transurethral resection of bladder tumor (TURBT).
MATERIALS AND METHODS
We conducted a multi-institutional retrospective study assessing 209 patients with high-risk NMIBC who underwent TURBT and subsequent adjuvant induction BCG therapy from December 1998 to April 2019. Patients were divided into 2 groups: those with preoperative estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m (non-CKD group), and those with eGFR < 60 ml/min/1.73 m (CKD group). Primary endpoints were intravesical recurrence-free survival (RFS) and muscle-invasive bladder cancer (MIBC)-free survival. Background-adjusted multivariate analyses with the inverse probability of treatment weighting (IPTW) method using the propensity score were performed to evaluate the impact of CKD on intravesical RFS, MIBC-free survival, metastasis-free survival, cancer-specific survival, and overall survival. Moreover, multivariable analyses were performed to assess the impact of CKD on intravesical recurrence and MIBC progression, adjusting for the competing risk of death using the Fine-Gray competing risk regression model.
RESULTS
Median age and follow-up period after TURBT were 72 years and 45 months, respectively. Of 209 patients, 71 (34%) were diagnosed with CKD before TURBT. Background-adjusted multivariate analyses with the IPTW method indicated that CKD was significantly associated with shorter intravesical RFS, MIBC-free survival, metastasis-free survival, cancer-specific survival, and overall survival. In the Fine-Gray competing risk regression model, CKD showed significantly higher probabilities of intravesical recurrence and MIBC progression, with an adjusted subdistribution hazard ratio of 1.886 (95% confidence interval 1.069-3.330, P = 0.028) and 3.740 (95% confidence interval 1.060-13.20, P = 0.040), respectively.
CONCLUSIONS
CKD presents a risk factor of poor oncological outcomes in patients with high-risk NMIBC who underwent adjuvant induction BCG therapy after TURBT.
目的
探讨辅助诱导卡介苗（BCG）治疗后经尿道膀胱肿瘤切除术（TURBT）治疗的高危非肌层浸润性膀胱癌（NMIBC）患者中慢性肾脏病（CKD）对肿瘤学结局的影响。
材料与方法
我们进行了一项多机构回顾性研究，评估了 209 例接受 TURBT 及随后辅助诱导 BCG 治疗的高危 NMIBC 患者，这些患者均于 1998 年 12 月至 2019 年 4 月期间接受治疗。患者分为 2 组：术前估算肾小球滤过率（eGFR）≥60ml/min/1.73m2（非 CKD 组）和 eGFR<60ml/min/1.73m2（CKD 组）。主要终点是膀胱内无复发生存（RFS）和肌肉浸润性膀胱癌（MIBC）无复发生存。采用逆概率治疗加权（IPTW）法进行背景调整的多变量分析，使用倾向评分评估 CKD 对膀胱内 RFS、MIBC 无复发生存、无转移生存、癌症特异性生存和总生存的影响。此外，使用 Fine-Gray 竞争风险回归模型，通过调整死亡竞争风险，对 CKD 对膀胱内复发和 MIBC 进展的影响进行多变量分析。
结果
209 例患者的中位年龄和 TURBT 后随访时间分别为 72 岁和 45 个月。209 例患者中，71 例（34%）在 TURBT 前被诊断为 CKD。采用 IPTW 法的背景调整多变量分析表明，CKD 与较短的膀胱内 RFS、MIBC 无复发生存、无转移生存、癌症特异性生存和总生存显著相关。在 Fine-Gray 竞争风险回归模型中，CKD 显示出更高的膀胱内复发和 MIBC 进展概率，调整后的亚分布风险比分别为 1.886（95%置信区间 1.069-3.330，P=0.028）和 3.740（95%置信区间 1.060-13.20，P=0.040）。
结论
在接受 TURBT 后接受辅助诱导 BCG 治疗的高危 NMIBC 患者中，CKD 是肿瘤学结局不良的危险因素。
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