Grover Sarika, Raj Siddarth, Russell Beth, Mensah Elsie, Nair Rajesh, Thurairaja Ramesh, Khan Muhammad Shamim, Thomas Kay, Malde Sachin
Faculty of Life Sciences and Medicine King's College London London UK.
Translational Oncology and Urology Research King's College London London UK.
BJUI Compass. 2021 Oct 13;3(2):124-129. doi: 10.1002/bco2.120. eCollection 2022 Mar.
The objective of this study is to determine the long-term efficacy and safety of office-based Holmium:YAG laser ablation for the treatment of recurrent non-muscle-invasive bladder cancer (NMIBC).
We retrospectively reviewed the medical records of all consecutive patients who underwent office-based laser ablation for recurrent bladder cancer between 2008 and 2016. The following data were collected: original histology, date of original histology, date of laser ablation, number of repeat laser ablation procedures required, date of tumor recurrence or progression, number of general anesthesia procedures (transurethral resection or cystodiathermy) required after first laser ablation, and number and severity of complications. Kaplan-Meier survival curves were produced for recurrence-free survival, progression-free survival, and overall survival.
A total of 97 patients, with an average age of 84 (62-98) years and an average Charlson Comorbidity Index of 6.9 (4-13), were included. The median follow-up was 61 (2-150) months. Fifty-five (56.7%) patients presented with tumor recurrence, and the median recurrence-free survival time was 1.69 years (95% CI 1.20-2.25). Only 9 (9.3%) patients had evidence of tumor progression to a higher grade or stage, 8 (89%) of which initially had low-grade tumors; however, no patient progressed to muscle-invasive disease. The median progression-free survival time was 5.70 years (95% CI 4.10-7.60), and the median overall survival time was 7.60 years (95% CI 4.90-8.70). No patient required emergency inpatient admission after laser ablation.
Office-based Holmium:YAG laser ablation offers a safe and effective alternative method for treating low-volume, low-grade recurrent NMIBC, especially in elderly patients with significant co-morbidity, while avoiding general anesthesia and inpatient admission.
本研究的目的是确定门诊钬激光消融术治疗复发性非肌层浸润性膀胱癌（NMIBC）的长期疗效和安全性。
我们回顾性分析了2008年至2016年间所有接受门诊激光消融术治疗复发性膀胱癌的连续患者的病历。收集了以下数据：原始组织学、原始组织学日期、激光消融日期、所需重复激光消融手术次数、肿瘤复发或进展日期、首次激光消融后所需全身麻醉手术（经尿道切除术或膀胱电灼术）次数以及并发症的数量和严重程度。绘制了无复发生存率、无进展生存率和总生存率的Kaplan-Meier生存曲线。
共纳入97例患者，平均年龄84（62-98）岁，平均Charlson合并症指数为6.9（4-13）。中位随访时间为61（2-150）个月。55例（56.7%）患者出现肿瘤复发，无复发生存时间的中位数为1.69年（95%CI 1.20-2.25）。只有9例（9.3%）患者有肿瘤进展至更高分级或分期的证据，其中8例（89%）最初为低级别肿瘤；然而，没有患者进展为肌层浸润性疾病。无进展生存时间的中位数为5.70年（95%CI 4.10-7.60），总生存时间的中位数为7.60年（95%CI 4.90-8.70）。激光消融术后无患者需要紧急住院治疗。
门诊钬激光消融术为治疗小体积、低级别复发性NMIBC提供了一种安全有效的替代方法，尤其适用于合并症严重的老年患者，同时避免了全身麻醉和住院治疗。
