Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Eur Urol Oncol. 2022 Apr;5(2):251-255. doi: 10.1016/j.euo.2021.05.002. Epub 2021 May 28.
Active surveillance (AS) has been proposed as an alternative to transurethral resection (TUR) in selected patients with recurrent low-risk non-muscle-invasive bladder cancer (NMIBC). Here we report long-term results for patients on AS and investigate features associated with AS failure. Cases with recurrence after diagnosis of low-grade (LG) pTa/pT1a NMIBC were enrolled in the Bladder Italian Active Surveillance (BIAS) project. Over 251 AS events, we observed 130 failures (51.8%). In these patients, final pathology showed 25 benign lesions (19.2%) and 92 LG Ta (70.7%), 12 high-grade Ta/T1 (9.2%), and one T2 (0.7%) tumor. The treatment-free probability at 12, 18, 24, and 36 mo was 59.7%, 54.5%, 46.3%, and 40.4%, respectively. We identified 95 patients (37.8%) who remained on AS for >18 mo. A multivariable Cox regression model confirmed that patients with a history of multiple TURs (hazard ratio [HR] 1.59, 95% confidence interval [CI] 1.01-2.51) and those with more than one lesion at AS entry (HR 1.63, 95% CI 1.05-2.54) were significantly more likely to experience AS failure. Our results confirm that well-selected patients with NMIBC can safely remain on AS for a long period of time. Multiple TURs and multiple lesions at AS enrollment are associated with a higher risk of AS failure. PATIENT SUMMARY: Active surveillance has been proposed as an alternative to surgery for patients with recurrent low-risk superficial bladder cancer. Our report confirms that well-selected patients can safely avoid or postpone surgery.
主动监测 (AS) 已被提议作为复发性低危非肌肉浸润性膀胱癌 (NMIBC) 患者的经尿道切除术 (TUR) 的替代方案。在这里，我们报告了接受 AS 治疗的患者的长期结果，并研究了与 AS 失败相关的特征。在诊断为低级别 (LG) pTa/pT1a NMIBC 后出现复发的病例被纳入膀胱意大利主动监测 (BIAS) 项目。在超过 251 次 AS 事件中，我们观察到 130 次失败 (51.8%)。在这些患者中，最终病理显示 25 例良性病变 (19.2%) 和 92 例 LG Ta (70.7%)、12 例高级别 Ta/T1 (9.2%) 和 1 例 T2 (0.7%) 肿瘤。12、18、24 和 36 个月时的无治疗概率分别为 59.7%、54.5%、46.3%和 40.4%。我们确定了 95 名 (37.8%) 患者的 AS 持续时间超过 18 个月。多变量 Cox 回归模型证实，有多次 TUR 病史的患者 (风险比 [HR] 1.59，95%置信区间 [CI] 1.01-2.51) 和 AS 入组时有多个病变的患者 (HR 1.63，95%CI 1.05-2.54) 发生 AS 失败的风险显著更高。我们的结果证实，选择合适的 NMIBC 患者可以安全地进行长时间的 AS。多次 TUR 和 AS 入组时的多个病变与 AS 失败的风险增加相关。患者总结：主动监测已被提议作为复发性低危浅表膀胱癌患者的手术替代方案。我们的报告证实，选择合适的患者可以安全地避免或推迟手术。
