卡介苗免疫疗法诱导治疗后对T1期非肌层浸润性膀胱癌患者进行膀胱肿瘤经尿道再切除分期可能与肿瘤学获益无关。
Restaging Transurethral Resection of Bladder Tumours after BCG Immunotherapy Induction in Patients with T1 Non-Muscle-Invasive Bladder Cancer Might not Be Associated with Oncologic Benefit.
作者信息
Krajewski Wojciech, Moschini Marco, Nowak Łukasz, Poletajew Sławomir, Tukiendorf Andrzej, Afferi Luca, Teoh Jeremy, Muilwijk Tim, Joniau Steven, Tafuri Alessandro, Antonelli Alessandro, Gozzo Alessandra, Mari Andrea, Di Trapani Ettore, Hendricksen Kees, Alvarez-Maestro Mario, Serrano Andrea Rodriguez, Simone Giuseppe, Zamboni Stefania, Simeone Claudio, Marconi Maria Cristina, Mastroianni Riccardo, Ploussard Guillaume, Rajwa Paweł, Laukhtina Ekaterina, Zdrojowy-Wełna Aleksandra, Kołodziej Anna, Paradysz Andrzej, Tully Karl, Krajewska Joanna, Piszczek Radosław, Xylinas Evanguelos, Zdrojowy Romuald
机构信息
Department of Urology and Oncologic Urology, Wrocław Medical University, 50-556 Wroclaw, Poland.
Klinik für Urologie, Luzerner Kantonsspital, 6004 Lucerne, Switzerland.
出版信息
J Clin Med. 2020 Oct 15;9(10):3306. doi: 10.3390/jcm9103306.
BACKGROUND AND PURPOSE
The European Association of Urology guidelines recommend restaging transurethral resection of bladder tumours (reTURB) 2-6 weeks after primary TURB. However, in clinical practice some patients undergo a second TURB procedure after Bacillus Calmette-Guérin immunotherapy (BCG)induction. To date, there are no studies comparing post-BCG reTURB with the classic pre-BCG approach. The aim of this study was to assess whether the performance of reTURB after BCG induction in T1HG bladder cancer is related to potential oncological benefits.
MATERIALS AND METHODS
Data from 645 patients with primary T1HG bladder cancer treated between 2001 and 2019 in 12 tertiary care centres were retrospectively reviewed. The study included patients who underwent reTURB before BCG induction (Pre-BCG group: 397 patients; 61.6%) and those who had reTURB performed after BCG induction (Post-BCG group: 248 patients, 38.4%). The decision to perform reTURB before or after BCG induction was according to the surgeon's discretion, as well as a consideration of local proceedings and protocols. Due to variation in patients' characteristics, both propensity-score-matched analysis (PSM) and inverse-probability weighting (IPW) were implemented.
RESULTS
The five-year recurrence-free survival (RFS) was 64.7% and 69.1% for the Pre- and Post-BCG groups, respectively, and progression-free survival (PFS) was 82.7% and 83.3% for the Pre- and Post-BCG groups, respectively (both: > 0.05). Similarly, neither RFS nor PFS differed significantly for a five-year period or in the whole time of observation after the PSM and IPW matching methods were used.
CONCLUSIONS
Our results suggest that there might be no difference in recurrence-free survival and progression-free survival rates, regardless of whether patients have reTURB performed before or after BCG induction.
背景与目的
欧洲泌尿外科学会指南推荐在初次经尿道膀胱肿瘤切除术（TURB）后2 - 6周进行再次经尿道膀胱肿瘤切除术（reTURB）。然而，在临床实践中，一些患者在卡介苗免疫疗法（BCG）诱导后接受了第二次TURB手术。迄今为止，尚无研究比较BCG诱导后的reTURB与经典的BCG诱导前方法。本研究的目的是评估T1期高级别膀胱癌患者在BCG诱导后进行reTURB是否具有潜在的肿瘤学益处。
材料与方法
回顾性分析了2001年至2019年期间在12个三级医疗中心接受治疗的645例原发性T1期高级别膀胱癌患者的数据。该研究包括在BCG诱导前接受reTURB的患者（BCG诱导前组：397例患者；61.6%）和在BCG诱导后接受reTURB的患者（BCG诱导后组：248例患者，38.4%）。在BCG诱导前或后进行reTURB的决定取决于外科医生的判断，以及对当地程序和方案的考虑。由于患者特征存在差异，因此实施了倾向评分匹配分析（PSM）和逆概率加权（IPW）。
结果
BCG诱导前组和BCG诱导后组的五年无复发生存率（RFS）分别为64.7%和69.1%，无进展生存率（PFS）分别为82.7%和83.3%（两者均：>0.05）。同样，在使用PSM和IPW匹配方法后，五年期或整个观察期内的RFS和PFS均无显著差异。
结论
我们的结果表明，无论患者在BCG诱导前还是诱导后进行reTURB，其无复发生存率和无进展生存率可能没有差异。
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