Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan.
Jpn J Clin Oncol. 2021 Aug 1;51(8):1303-1312. doi: 10.1093/jjco/hyab060.
The relationship between guideline adherence for radical cystectomy of non-muscle-invasive bladder cancer and patient prognoses currently remains unclear. We investigated whether guideline adherence at the time of non-muscle-invasive bladder cancer affects the oncological outcomes of bladder cancer patients who underwent radical cystectomy.
Among 267 cTa-4N0-2M0 bladder cancer patients, 70 who underwent radical cystectomy under the non-muscle-invasive bladder cancer or muscle-invasive bladder cancer status that progressed from non-muscle-invasive bladder cancer were identified. Patients who followed the guidelines from initial transurethral resection of bladder tumors to radical cystectomy were defined as the guideline adherent group (n = 52), while those who did not were the guideline non-adherent group (n = 18).
In the guideline non-adherent group, 8 (44.4%) out of 18 were diagnosed with highest risk non-muscle-invasive bladder cancer for Bacillus Calmette Guérin-naïve patients and 7 (38.9%) had a Bacillus Calmette Guérin unresponsive tumor status. Five-year recurrence-free survival and cancer-specific survival rates for the guideline non-adherent group vs guideline adherent group were 38.9% vs 69.8% (P = 0.018) and 52.7% vs 80.1% (P = 0.006), respectively. A multivariate analysis identified guideline non-adherence as one of independent indicators for disease recurrence (hazard ratio = 2.81, P = 0.008) and cancer-specific death (hazard ratio = 4.04, P = 0.003). In a subgroup analysis of 49 patients with cT1 or less non-muscle-invasive bladder cancer at the time of radical cystectomy, guideline non-adherence remained an independent prognostic factor for cancer-specific survival (hazard ratio = 3.46, P = 0.027).
Guideline adherence during the time course of the non-muscle-invasive bladder cancer stage may result in a favorable prognosis of patients who receive radical cystectomy. Even under non-muscle-invasive bladder cancer status, radical cystectomy needs to be performed with adequate timing under guideline recommendations.
目前，非肌层浸润性膀胱癌根治性切除术的指南遵循情况与患者预后之间的关系尚不清楚。我们研究了非肌层浸润性膀胱癌时的指南遵循情况是否会影响接受根治性膀胱切除术的膀胱癌患者的肿瘤学结局。
在 267 例 cTa-4N0-2M0 膀胱癌患者中，确定了 70 例因非肌层浸润性膀胱癌进展至肌层浸润性膀胱癌而行根治性膀胱切除术的患者。从经尿道膀胱肿瘤切除术到根治性膀胱切除术均遵循指南的患者定义为指南遵循组（n=52），而不遵循指南的患者定义为指南不遵循组（n=18）。
在指南不遵循组中，18 例中有 8 例（44.4%）为初治卡介苗敏感的最高危非肌层浸润性膀胱癌，7 例（38.9%）为卡介苗无反应性肿瘤状态。指南不遵循组和指南遵循组的 5 年无复发生存率和癌症特异性生存率分别为 38.9%和 69.8%（P=0.018）和 52.7%和 80.1%（P=0.006）。多变量分析发现，指南不遵循是疾病复发的独立指标之一（风险比=2.81，P=0.008）和癌症特异性死亡（风险比=4.04，P=0.003）。在根治性膀胱切除时 cT1 或更低的非肌层浸润性膀胱癌的 49 例患者的亚组分析中，指南不遵循仍然是癌症特异性生存的独立预后因素（风险比=3.46，P=0.027）。
非肌层浸润性膀胱癌阶段的指南遵循可能导致接受根治性膀胱切除术的患者获得良好的预后。即使在非肌层浸润性膀胱癌状态下，根治性膀胱切除术也需要根据指南建议在适当的时机进行。
