Department of Urology, University of Miami Miller School of Medicine, Miami, Florida.
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
J Urol. 2021 Jul;206(1):22-28. doi: 10.1097/JU.0000000000001689. Epub 2021 Feb 22.
We sought to determine the optimal cystoscopic interval for intermediate risk, nonmuscle invasive bladder cancer.
A retrospective analysis of patients with intermediate risk, nonmuscle invasive bladder cancer (2010-2017) was performed and 3 hypothetical models of surveillance intensity were applied: model 1: high (3 months), model 2: moderate (6 months) and model 3: low intensity (12 months) over a 2-year period. We compared timing of actual detection of recurrence and progression to proposed cystoscopy timing between each model. We calculated number of avoidable cystoscopies and associated costs.
Of 107 patients with median followup of 37 months, 66/107 (77.6%) developed recurrence and 12/107(14.1%) had progression. Relative to model 1, there were 33 (50%) delayed detection of recurrences in model 2 and 41 (62%) in model 3. There was a 1.7-month mean delay in detection of recurrence for model 1 vs 3.2, and a 7.6-month delay for models 2 and 3 (p <0.001 model 1 vs 2; p <0.001 model 2 vs 3). Relative to model 1, there were 8 (67%) and 9 (75%) delayed detection of progression events in model 2 and 3. There were no progression-related bladder cancer deaths or radical cystectomies due to delayed detection. Mean number of avoidable cystoscopies was higher in model 1 (2) vs model 2 (1) and 3 (0). Model 1 had the highest aggregate cost of surveillance ($46,262.52).
High intensity (3-month) surveillance intervals provide faster detection of recurrences but with increased cost and more avoidable cystoscopies without clear oncologic benefit. Moderate intensity (6-month) intervals in intermediate risk, nonmuscle invasive bladder cancer allows timely detection without oncologic compromise and is less costly with fewer cystoscopies.
我们旨在确定中危非肌肉浸润性膀胱癌的最佳膀胱镜检查间隔。
对 2010 年至 2017 年间患有中危非肌肉浸润性膀胱癌的患者进行回顾性分析，并应用 3 种不同的监测强度假设模型：模型 1：高（3 个月），模型 2：中（6 个月）和模型 3：低强度（12 个月），在 2 年内进行监测。我们比较了实际复发和进展时间与每个模型建议的膀胱镜检查时间。我们计算了可避免的膀胱镜检查数量和相关成本。
在中位随访 37 个月的 107 例患者中，66/107（77.6%）例发生复发，12/107（14.1%）例发生进展。与模型 1 相比，模型 2 中有 33 例（50%）和模型 3 中有 41 例（62%）出现复发延迟检测。模型 1 与模型 3 相比，检测到复发的平均延迟时间为 1.7 个月，模型 2 和 3 的延迟时间为 7.6 个月（p<0.001 模型 1 与 2；p<0.001 模型 2 与 3）。与模型 1 相比，模型 2 和 3 分别有 8 例（67%）和 9 例（75%）出现进展延迟检测。由于检测延迟，没有与进展相关的膀胱癌死亡或根治性膀胱切除术。模型 1 （2 次）可避免膀胱镜检查的数量明显高于模型 2 （1 次）和 3 （0 次）。模型 1 的监测总费用最高（46262.52 美元）。
高强度（3 个月）监测间隔可更快地检测到复发，但成本更高，可避免的膀胱镜检查更多，而无明确的肿瘤学获益。中危非肌肉浸润性膀胱癌的中强度（6 个月）间隔可及时发现，而不会对肿瘤学造成影响，且成本更低，膀胱镜检查次数更少。
