European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands.
Department of Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain.
Eur Urol. 2021 Apr;79(4):480-488. doi: 10.1016/j.eururo.2020.12.033. Epub 2021 Jan 6.
BACKGROUND: The European Association of Urology (EAU) prognostic factor risk groups for non-muscle-invasive bladder cancer (NMIBC) are used to provide recommendations for patient treatment after transurethral resection of bladder tumor (TURBT). They do not, however, take into account the widely used World Health Organization (WHO) 2004/2016 grading classification and are based on patients treated in the 1980s. OBJECTIVE: To update EAU prognostic factor risk groups using the WHO 1973 and 2004/2016 grading classifications and identify patients with the lowest and highest probabilities of progression. DESIGN, SETTING, AND PARTICIPANTS: Individual patient data for primary NMIBC patients were collected from the institutions of the members of the EAU NMIBC guidelines panel. INTERVENTION: Patients underwent TURBT followed by intravesical instillations at the physician's discretion. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable Cox proportional-hazards regression models were fitted to the primary endpoint, the time to progression to muscle-invasive disease or distant metastases. Patients were divided into four risk groups: low-, intermediate-, high-, and a new, very high-risk group. The probabilities of progression were estimated using Kaplan-Meier curves. RESULTS AND LIMITATIONS: A total of 3401 patients treated with TURBT ± intravesical chemotherapy were included. From the multivariable analyses, tumor stage, WHO 1973/2004-2016 grade, concomitant carcinoma in situ, number of tumors, tumor size, and age were used to form four risk groups for which the probability of progression at 5 yr varied from <1% to >40%. Limitations include the retrospective collection of data and the lack of central pathology review. CONCLUSIONS: This study provides updated EAU prognostic factor risk groups that can be used to inform patient treatment and follow-up. Incorporating the WHO 2004/2016 and 1973 grading classifications, a new, very high-risk group has been identified for which urologists should be prompt to assess and adapt their therapeutic strategy when necessary. PATIENT SUMMARY: The newly updated European Association of Urology prognostic factor risk groups for non-muscle-invasive bladder cancer provide an improved basis for recommending a patient's treatment and follow-up schedule.
背景：欧洲泌尿外科学会（EAU）的非肌肉浸润性膀胱癌（NMIBC）预后因素风险组用于为经尿道膀胱肿瘤切除术（TURBT）后患者的治疗提供建议。然而，它们并未考虑广泛使用的世界卫生组织（WHO）2004/2016 年分级分类，并且基于 20 世纪 80 年代接受治疗的患者。
目的：使用 WHO 1973 年和 2004/2016 年分级分类更新 EAU 预后因素风险组，并确定进展可能性最低和最高的患者。
设计、地点和参与者：从 EAU NMIBC 指南小组机构收集了原发性 NMIBC 患者的个体患者数据。
干预：患者接受 TURBT 治疗，然后根据医生的判断进行膀胱内灌注。
结局测量和统计分析：多变量 Cox 比例风险回归模型用于主要终点，即进展为肌层浸润性疾病或远处转移的时间。患者分为四个风险组：低风险、中风险、高风险和一个新的、极高风险组。使用 Kaplan-Meier 曲线估计进展概率。
结果和局限性：共纳入 3401 例接受 TURBT ± 膀胱内化疗治疗的患者。多变量分析中，肿瘤分期、WHO 1973/2004-2016 分级、同时存在原位癌、肿瘤数量、肿瘤大小和年龄用于形成四个风险组，其 5 年进展概率从<1%到>40%不等。局限性包括数据的回顾性收集和缺乏中心病理审查。
结论：本研究提供了可用于告知患者治疗和随访的更新后的 EAU 预后因素风险组。纳入 WHO 2004/2016 年和 1973 年分级分类后，确定了一个新的极高风险组，泌尿科医生应及时评估并在必要时调整其治疗策略。
患者总结：新更新的欧洲泌尿外科学会非肌肉浸润性膀胱癌预后因素风险组为推荐患者的治疗和随访计划提供了更好的基础。
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