Abushamma Faris, Khayyat Zain, Soroghle Aya, H Zyoud Sa'ed, Jaradat Ahmad, Akkawi Maha, Aburass Hanood, Qaddumi Iyad K K, Odeh Razan, Salameh Husam, Albuheissi Salah
Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
Department of Urology, An-Najah National University Hospital, Nablus, 44839, Palestine.
Cancer Manag Res. 2021 Mar 31;13:2937-2945. doi: 10.2147/CMAR.S299148. eCollection 2021.
Non-muscle invasive bladder cancer (NMIBC) is a potentially curable or controllable disease if strict adherence to a surveillance protocol is followed. Management and surveillance of NMIBC begins at the time of diagnosis up to a few years thereafter. There is scanty data in the literature evaluating the impact of non-compliance with the surveillance protocols on progression, recurrence, and mortality rate.
An observational, retrospective cohort study recruited data between 2012 and 2017 at two tertiary hospitals. Data were collected consecutively. NMIBC patients who had at least 3 years of follow-up data were included. Patients were divided into different groups based on their compliance with the cystoscopy follow-up protocol as recommended by the European guidelines. We compared the cystoscopy compliant group with the non-compliant group in view of recurrence, progression, and mortality. In addition, missing variable items during surveillance were calculated using a new scoring model to predict adverse outcomes.
Eighty-eight NMIBC patients met our criteria. Recurrence rate (RR), progression rate (PR), metastasis rate (MsR), and mortality rate (MR) are significantly higher in non-compliant group, RR: (92.6%) (<0.001), PR: (54.1%) (<0.001), MsR: (37.7%) (<0.001), MR: (23.5%) (= 0.002) respectively. In the subgroup analysis, intermediate and high-risk groups have a PR rate of zero in the compliant group, while it is 100% (<0.001) and 56.4% (=0.001) in the non-compliant group, respectively. Use of a Kaplan Meier (KM) graph shows that compliant patients had a better survival in comparison to non-compliant patients. Scoring there or more is statistically and clinically significantly associated with higher recurrence, progression, and mortality. RR: (94%) (=0.016), PR: 49% (<0.001) and MR (26%) (=0.012).
Non-compliance to a standardized surveillance protocol in NMIBC is associated statistically and clinically with adverse outcomes in comparison to a compliant group. This mandates strict adherence to surveillance guidelines particularly in patients with high-risk disease.
如果严格遵循监测方案，非肌层浸润性膀胱癌（NMIBC）是一种潜在可治愈或可控的疾病。NMIBC的管理和监测从诊断时开始，持续数年。文献中评估不遵守监测方案对疾病进展、复发和死亡率影响的数据很少。
一项观察性回顾性队列研究收集了2012年至2017年两家三级医院的数据。数据连续收集。纳入至少有3年随访数据的NMIBC患者。根据患者对欧洲指南推荐的膀胱镜检查随访方案的依从性，将患者分为不同组。我们从复发、进展和死亡率方面比较了膀胱镜检查依从组和不依从组。此外，使用一种新的评分模型计算监测期间缺失的变量项，以预测不良结局。
88例NMIBC患者符合我们的标准。不依从组的复发率（RR）、进展率（PR）、转移率（MsR）和死亡率（MR）显著更高，RR分别为（92.6%）（<0.001），PR为（54.1%）（<0.001），MsR为（37.7%）（<0.001），MR为（23.5%）（=0.002）。在亚组分析中，依从组中高危和中危组的PR率为零，而不依从组分别为100%（<0.001）和56.4%（=0.001）。使用Kaplan Meier（KM）图显示，与不依从患者相比，依从患者的生存率更高。评分达到三分或更高在统计学和临床上与更高的复发、进展和死亡率显著相关。RR为（94%）（=0.016），PR为49%（<0.001），MR为（26%）（=0.012）。
与依从组相比，NMIBC患者不遵守标准化监测方案在统计学和临床上均与不良结局相关。这就要求严格遵守监测指南，尤其是高危疾病患者。
