Department of Urology, Radboud university medical center, Nijmegen, The Netherlands.
Department of Urology, Radboud university medical center, Nijmegen, The Netherlands; Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands.
Cancer Treat Res Commun. 2020;25:100264. doi: 10.1016/j.ctarc.2020.100264. Epub 2020 Dec 4.
Despite treatment with radical cystectomy, patients with muscle invasive bladder cancer (MIBC) have a poor survival. It has been reported that survival is worse in NMIBC patients who progressed to MIBC in comparison to patients with de novo MIBC. The objective of this study was to compare survival of progressive versus de novo MIBC. Secondary objective was to explain this difference in survival by clinicopathological factors.
431 patients with MIBC who underwent radical cystectomy between 1998 and 2016 in the Radboudumc, Nijmegen, were retrospectively analyzed. 313 patients were identified with de novo MIBC and 118 with progressive MIBC.
5- and 10-year overall survival (OS) of patients with progressive MIBC was 37% and 20%, respectively. Patients with de novo MIBC had significantly better survival, with a 5- and 10-year OS of 49% and 39%, respectively. Patients with progressive MIBC were more frequently diagnosed with concomitant carcinoma in situ and positive surgical margins in bladder, ureters or urethra. In multivariable analysis that adjusted for these factors, progressive MIBC was associated with a hazard ratio of 1.40 (0.99 - 1.98). Kaplan-Meier survival curves show a detrimental effect of progressive MIBC in patients with pT2 versus pT3-4 tumors and in patients with negative versus positive surgical margins. In multivariable analysis, this effect modification disappeared.
Progressive MIBC is associated with poorer survival than de novo MIBC. Because most patients with progressive MIBC had a history of high risk NMIBC, considering radical cystectomy is most important in the highest risk NMIBC.
尽管接受了根治性膀胱切除术，肌层浸润性膀胱癌（MIBC）患者的生存状况仍较差。据报道，与初发 MIBC 患者相比，进展为 MIBC 的非肌层浸润性膀胱癌（NMIBC）患者的生存状况更差。本研究旨在比较进展性和初发性 MIBC 的生存情况。次要目标是通过临床病理因素来解释这种生存差异。
回顾性分析了 1998 年至 2016 年在拉德堡德大学医学中心接受根治性膀胱切除术的 431 例 MIBC 患者。其中 313 例为初发性 MIBC，118 例为进展性 MIBC。
进展性 MIBC 患者的 5 年和 10 年总生存率（OS）分别为 37%和 20%。初发性 MIBC 患者的生存情况明显更好，5 年和 10 年 OS 分别为 49%和 39%。进展性 MIBC 患者更常被诊断为同时存在原位癌和膀胱、输尿管或尿道的阳性切缘。多变量分析调整这些因素后，进展性 MIBC 的风险比为 1.40（0.99-1.98）。Kaplan-Meier 生存曲线显示，在 pT2 与 pT3-4 肿瘤以及在阴性与阳性切缘患者中，进展性 MIBC 具有不利影响。多变量分析中，这种效应修饰消失了。
进展性 MIBC 比初发性 MIBC 患者的生存状况更差。由于大多数进展性 MIBC 患者有高危 NMIBC 病史，因此在最高危 NMIBC 中考虑根治性膀胱切除术最为重要。
