Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Urology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
BJU Int. 2021 Nov;128(5):568-574. doi: 10.1111/bju.15344. Epub 2021 Feb 15.
To evaluate the impact of upper tract urothelial carcinoma (UTUC) on bacillus Calmette-Guerin (BCG) response and progression in patients with non-muscle-invasive bladder cancer (NMIBC).
We performed an institutional review board-approved review of patients with NMIBC treated with adequate intravesical BCG, as defined by the US Food and Drug Administration, at our institution between 2000 and 2018. Patients were stratified by presence of any UTUC and time of UTUC diagnosis (preceding vs synchronous to NMIBC diagnosis or metachronous disease after NMIBC diagnosis). Descriptive statistics were used to summarize the data overall and by groups, and t-tests or Wilcoxon's rank sum tests and Pearson's chi-squared or Fisher's exact tests were used to analyse continuous and categorical data, respectively.
Of 541 patients with NMIBC treated with adequate BCG, 59 (10.9 %) were diagnosed with UTUC. Of these, 34 had a history of UTUC prior to NMIBC (UTUC-P; median [interquartile range {IQR}] 13.1 [7.4-27.6] months prior), while 25 developed UTUC after diagnosis of NMIBC (six synchronous and 19 metachronous; median [IQR] 12.1 [1.7-28.1] months after). Compared to the non-UTUC group, patients with UTUC-P were more likely to exhibit Tis without papillary tumour in the bladder (20.6% vs 5.0%; P < 0.001), but were less likely to have T1 disease on index transurethral resection (8.8% vs 49.4%; P < 0.001). Patients with UTUC-P developed more recurrences (55.9% vs 34.0%; P = 0.010), any stage/grade progression (23.5% vs 9.8%; P = 0.012) and progression to muscle-invasive or metastatic disease (17.6% vs 6.4%; P = 0.014). The presence of high-grade UTUC-P compared to low-grade UTUC-P was associated with increased NMIBC recurrence (68.2% vs 25.0%; P = 0.049). There was no significant difference in rates of recurrence or progression based on timing of UTUC with respect to the index bladder tumour, although this analysis was limited by small numbers.
Presence of UTUC prior to a diagnosis of NMIBC was associated with an almost twofold increased recurrence and progression rates after adequate BCG therapy. This should be considered when counselling patients and designing cohorts for clinical trials.
评估上尿路上皮癌（UTUC）对接受卡介苗（BCG）治疗的非肌层浸润性膀胱癌（NMIBC）患者BCG 反应和进展的影响。
我们对本机构 2000 年至 2018 年间接受足够的膀胱内 BCG 治疗的 NMIBC 患者进行了机构审查委员会批准的回顾性分析，BCG 治疗足够的定义为符合美国食品和药物管理局的标准。根据是否存在任何 UTUC 以及 UTUC 的诊断时间（先于 NMIBC 诊断、与 NMIBC 诊断同时或 NMIBC 诊断后发生）对患者进行分层。使用描述性统计来总结总体和组内数据，使用 t 检验或 Wilcoxon 秩和检验以及 Pearson 卡方检验或 Fisher 确切检验分别分析连续和分类数据。
在 541 例接受足够 BCG 治疗的 NMIBC 患者中，有 59 例（10.9%）被诊断为 UTUC。其中 34 例在 NMIBC 之前有 UTUC 病史（UTUC-P；中位数[四分位距{IQR}]为 13.1[7.4-27.6]个月前），而 25 例在诊断为 NMIBC 后发生 UTUC（6 例同步，19 例为异时性；中位数[IQR]为 12.1[1.7-28.1]个月后）。与非 UTUC 组相比，UTUC-P 患者更有可能出现Tis 而无膀胱内乳头状肿瘤（20.6%比 5.0%；P<0.001），但更不可能在指数经尿道切除术时出现 T1 疾病（8.8%比 49.4%；P<0.001）。UTUC-P 患者发生更多复发（55.9%比 34.0%；P=0.010）、任何阶段/分级进展（23.5%比 9.8%；P=0.012）和进展为肌层浸润性或转移性疾病（17.6%比 6.4%；P=0.014）。与低级别 UTUC-P 相比，高级别 UTUC-P 与 NMIBC 复发增加相关（68.2%比 25.0%；P=0.049）。尽管由于样本量小，基于 UTUC 与指数膀胱肿瘤时间的关系，复发或进展的发生率没有差异，但分析结果表明存在这种关联。
在诊断为 NMIBC 之前存在 UTUC 与接受足够 BCG 治疗后的复发和进展率几乎增加一倍相关。在为患者提供咨询和为临床试验设计队列时应考虑到这一点。
