Tan Wei Shen, Contieri Roberto, Buffi Nicolò Maria, Lughezzani Giovanni, Grajales Valentina, Soloway Mark, Casale Paolo, Hurle Rodolfo, Kamat Ashish M
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
J Urol. 2023 Nov;210(5):763-770. doi: 10.1097/JU.0000000000003639. Epub 2023 Aug 3.
We sought to determine if the International Bladder Cancer Group IR-NMIBC (Intermediate-risk Nonmuscle-invasive Bladder Cancer) scoring system can predict the requirement of delayed transurethral resection of bladder tumor in low-grade nonmuscle-invasive bladder cancer managed by active surveillance.
We prospectively studied recurrent low-grade Ta/T1 nonmuscle-invasive bladder cancer patients managed with active surveillance with the following characteristics: low-grade papillary nonmuscle-invasive bladder cancer, ≤5 apparent low-grade nonmuscle-invasive bladder tumors, tumor diameter ≤1 cm, absence of gross hematuria, and negative urinary cytology. Subsequent transurethral resection of bladder tumor was offered to patients who no longer met the inclusion criteria or patient choice. The ability of the International Bladder Cancer Group IR-NMIBC scoring system to predict receipt of subsequent transurethral resection of bladder tumor was determined. Multivariable Cox proportional hazards analysis was used to determine factors associated with subsequent transurethral resection of bladder tumor.
A total of 163 patients with low-grade Ta/T1 nonmuscle-invasive bladder cancer were included for analysis. After a median follow-up of 33 months (IQR: 21-46), transurethral resection of bladder tumor was performed on 109 patients. At landmark time point of 24 months, patients with 0 risk factors were over 2-fold more likely to continue active surveillance compared to patients with ≥3 risk factors (59% vs 24%). Multivariable Cox regression suggested that the International Bladder Cancer Group IR-NMIBC scoring system was associated with subsequent transurethral resection of bladder tumor (1-2 risk factors [HR: 1.66, 95% CI: 0.96-2.90, = .072], ≥3 risk factors [HR: 3.21, 95% CI: 1.70-6.09, < .001]) after adjusting for age, T stage, and sex.
The International Bladder Cancer Group IR-NMIBC scoring system can predict the risk of subsequent transurethral resection of bladder tumor in patients with low-grade nonmuscle-invasive bladder cancer on active surveillance.
我们试图确定国际膀胱癌小组的IR-NMIBC（中危非肌层浸润性膀胱癌）评分系统能否预测在接受主动监测的低级别非肌层浸润性膀胱癌患者中延迟进行经尿道膀胱肿瘤切除术的必要性。
我们前瞻性地研究了接受主动监测的复发性低级别Ta/T1期非肌层浸润性膀胱癌患者，这些患者具有以下特征：低级别乳头状非肌层浸润性膀胱癌、≤5个明显的低级别非肌层浸润性膀胱肿瘤、肿瘤直径≤1 cm、无肉眼血尿且尿细胞学检查阴性。对于不再符合纳入标准或患者自主选择的患者，会进行后续的经尿道膀胱肿瘤切除术。我们确定了国际膀胱癌小组的IR-NMIBC评分系统预测后续经尿道膀胱肿瘤切除术的能力。采用多变量Cox比例风险分析来确定与后续经尿道膀胱肿瘤切除术相关的因素。
总共纳入了163例低级别Ta/T1期非肌层浸润性膀胱癌患者进行分析。中位随访33个月（四分位间距：21 - 46个月）后，109例患者接受了经尿道膀胱肿瘤切除术。在24个月的标志性时间点，与具有≥3个风险因素的患者相比，具有0个风险因素的患者继续进行主动监测的可能性高出2倍多（59%对24%）。多变量Cox回归分析表明，在调整年龄、T分期和性别后，国际膀胱癌小组的IR-NMIBC评分系统与后续经尿道膀胱肿瘤切除术相关（1 - 2个风险因素[风险比：1.66，95%置信区间：0.96 - 2.90，P = 0.072]，≥3个风险因素[风险比：3.21，95%置信区间：1.70 - 6.09，P < 0.001]）。
国际膀胱癌小组的IR-NMIBC评分系统能够预测接受主动监测的低级别非肌层浸润性膀胱癌患者后续经尿道膀胱肿瘤切除术的风险。
