Department of Urology, Acıpayam State Hospital, Denizli, Turkey.
Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey.
J Urol. 2024 Jul;212(1):104-113. doi: 10.1097/JU.0000000000003990. Epub 2024 May 1.
We aimed to compare recurrence-free survival (RFS) and progression-free survival (PFS) of the patients with pure high-grade (HG) vs mixed-grade (MG) nonmuscle-invasive bladder cancer who received adequate bacillus Calmette-Guérin therapy.
We conducted a retrospective cohort analysis using data from an institutional database. The study included patients diagnosed with HG nonmuscle-invasive bladder cancer at the initial transurethral resection specimen between 2010 and 2020. The initial transurethral resection specimens of all patients were reevaluated by a dedicated uropathologist. The percentage of low-grade tumor areas accompanying HG areas was determined for each case. Time-to-event analysis was performed using the Kaplan-Meier method. RFS and PFS rates were compared between groups.
Of the 203 patients enrolled in the study, 69 (34%) had MG tumors. Recurrence was observed in 41 out of 134 patients (30.6%) in the HG group and in 19 out of 69 patients (27.5%) in the MG group. The 36-month RFS rates were 69% (CI: 62-77) and 72% (CI: 62-83) for the HG-urothelial carcinoma (UC) and MG-UC groups, respectively. The RFS rates were similar between groups (log-rank, = .58). Progression was observed in 22 out of 134 patients (16.4%) in the HG group and in 4 out of 69 patients (5.8%) in the MG group. The 36-month PFS rates were 84% (CI: 77-90) and 94% (CI: 89-100) for the HG-UC and MG-UC groups, respectively. The pure HG-UC group had a worse PFS than the MG-UC group (log-rank, = .042). Multivariate analysis demonstrated that age and tumor grade were significant risk factors for the development of progression.
The indication of MG-UC category separately from pure HG carcinomas in the pathology report seems to be an important issue that can guide patient management. In this way, both more accurate risk classification and more accurate patient counseling can be performed. More importantly, the treatment plan can be made more accurately. For more precise conclusions, our results should be supported by prospective studies with larger sample size.
我们旨在比较接受充分卡介苗治疗的单纯高级别（HG）与混合级别（MG）非肌肉浸润性膀胱癌患者的无复发生存率（RFS）和无进展生存率（PFS）。
我们使用机构数据库中的数据进行了回顾性队列分析。本研究纳入了 2010 年至 2020 年间在初始经尿道膀胱肿瘤切除术标本中诊断为 HG 非肌肉浸润性膀胱癌的患者。所有患者的初始经尿道膀胱肿瘤切除术标本均由专门的泌尿科病理学家重新评估。确定每个病例中 HG 区域伴随的低级别肿瘤区域的百分比。使用 Kaplan-Meier 方法进行生存时间分析。比较各组之间的 RFS 和 PFS 率。
在纳入的 203 例患者中，69 例（34%）患有 MG 肿瘤。HG 组中有 41 例（30.6%）和 MG 组中有 19 例（27.5%）患者出现复发。HG-尿路上皮癌（UC）和 MG-UC 组的 36 个月 RFS 率分别为 69%（CI：62-77）和 72%（CI：62-83）。两组间 RFS 率相似（对数秩检验， =.58）。HG 组中有 22 例（16.4%）和 MG 组中有 4 例（5.8%）患者出现进展。HG-UC 和 MG-UC 组的 36 个月 PFS 率分别为 84%（CI：77-90）和 94%（CI：89-100）。纯 HG-UC 组的 PFS 劣于 MG-UC 组（对数秩检验， =.042）。多变量分析表明，年龄和肿瘤分级是进展发生的显著危险因素。
在病理报告中将 MG-UC 类别与纯 HG 癌分开似乎是一个重要问题，可以指导患者管理。通过这种方式，可以进行更准确的风险分类和更准确的患者咨询。更重要的是，可以更准确地制定治疗计划。为了得出更准确的结论，我们的结果应得到更大样本量的前瞻性研究的支持。
