Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
PLoS One. 2023 Feb 10;18(2):e0275921. doi: 10.1371/journal.pone.0275921. eCollection 2023.
The optimal frequency and duration of surveillance in patients with high-risk non-muscle-invasive bladder cancer (NMIBC) remain unclear. The aim of the present study is to develop an optimal surveillance protocol based on the European Association of Urology (EAU) substratification in order to improve surveillance costs after transurethral resection of bladder tumor (TURBT) in patients with primary high-risk NMIBC.
We retrospectively evaluated 428 patients with primary high-risk NMIBC who underwent TURBT from November 1993 to April 2019. Patients were substratified into the highest-risk and high-risk without highest-risk groups based on the EAU guidelines. An optimized surveillance protocol that enhances cost-effectiveness was then developed using real incidences of recurrence after TURBT. A recurrence detection rate ([number of patients with recurrence / number of patients with surveillance] × 100) of ≥ 1% during a certain period indicated that routine surveillance was necessary in this period. The 10-year total surveillance cost was compared between the EAU guidelines-based protocol and the optimized surveillance protocol developed herein.
Among the 428 patients with primary high-risk NMIBC, 97 (23%) were substratified into the highest-risk group. Patients in the highest-risk group had a significantly shorter recurrence-free survival than those in the high-risk without highest-risk group. The optimized surveillance protocol promoted a 40% reduction ($394,990) in the 10-year total surveillance cost compared to the EAU guidelines-based surveillance protocol.
The optimized surveillance protocol based on the EAU substratification could potentially reduce over investigation during follow-up and improve surveillance costs after TURBT in patients with primary high-risk NMIBC.
高危非肌层浸润性膀胱癌（NMIBC）患者的最佳监测频率和持续时间仍不清楚。本研究旨在制定基于欧洲泌尿外科学会（EAU）分层的最佳监测方案，以改善原发性高危 NMIBC 患者经尿道膀胱肿瘤切除术（TURBT）后的监测成本。
我们回顾性评估了 1993 年 11 月至 2019 年 4 月期间接受 TURBT 的 428 例原发性高危 NMIBC 患者。根据 EAU 指南，患者被分层为最高危和高危无最高危组。然后，使用 TURBT 后复发的实际发生率，制定了一种增强成本效益的优化监测方案。在一定时期内，复发检出率（[复发患者数/监测患者数]×100）≥1%，表明在此期间需要常规监测。比较了 EAU 指南监测方案和本文开发的优化监测方案的 10 年总监测成本。
在 428 例原发性高危 NMIBC 患者中，97 例（23%）被分层为最高危组。最高危组患者的无复发生存率明显短于高危无最高危组患者。与 EAU 指南监测方案相比，优化监测方案可将 10 年总监测成本降低 40%（394990 美元）。
基于 EAU 分层的优化监测方案可能会减少随访期间的过度检查，并改善原发性高危 NMIBC 患者 TURBT 后的监测成本。
