Nishimura Nobutaka, Miyake Makito, Miyamoto Tatsuki, Shimizu Takuto, Fujii Tomomi, Morizawa Yosuke, Hori Shunta, Gotoh Daisuke, Nakai Yasushi, Torimoto Kazumasa, Tanaka Nobumichi, Fujimoto Kiyohide
Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
Department of Diagnostic Pathology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
Adv Urol. 2024 May 21;2024:5894288. doi: 10.1155/2024/5894288. eCollection 2024.
Although routine surveillance imaging to examine upper urinary tract urothelial cancer recurrence during follow-up of nonmuscle invasive bladder cancer is recommended, its necessity remains invalidated. A single-institute long-term follow-up cohort study to evaluate the clinical impact of routine surveillance imaging and identify risk factors for upper urinary tract urothelial cancer recurrence after nonmuscle invasive bladder cancer treatment was conducted.
A retrospective chart review of 864 patients with primary nonmuscle invasive bladder cancer who underwent initial transurethral resection of bladder tumor between 1980 and 2020 was conducted. The opportunities to diagnose its recurrence were examined. Moreover, oncological outcomes included upper urinary tract urothelial cancer recurrence-free survival and overall survival.
Of 864 patients, 19 (2.2%) experienced upper urinary tract urothelial cancer recurrence. Among 19 patients, recurrence was detected through routine imaging in 12 (63.2%), cystoscopy in 2 (10.5%), urine cytology in 2 (10.5%), and presence of gross hematuria in 1 (5.3%). All patients had high- or highest-risk NMIBC at diagnosis of primary nonmuscle invasive bladder cancer. On multivariate Fine-Gray proportional regression analyses, a tumor size of ≥30 mm and carcinoma in situ were independently associated with short upper urinary tract urothelial cancer recurrence-free survival (=0.040 and 0.0089, respectively).
Most patients experiencing upper urinary tract urothelial cancer recurrence were diagnosed by routine surveillance imaging, suggesting its clinical importance, especially for patients with nonmuscle invasive bladder cancer accompanied by a tumor size of ≥30 mm and carcinoma in situ.
尽管建议在非肌层浸润性膀胱癌随访期间进行常规监测成像以检查上尿路尿路上皮癌复发情况，但其必要性仍未得到证实。本研究开展了一项单机构长期随访队列研究，以评估常规监测成像的临床影响，并确定非肌层浸润性膀胱癌治疗后上尿路尿路上皮癌复发的危险因素。
对1980年至2020年间接受初次经尿道膀胱肿瘤切除术的864例原发性非肌层浸润性膀胱癌患者进行回顾性病历审查。检查诊断其复发的机会。此外，肿瘤学结局包括上尿路尿路上皮癌无复发生存率和总生存率。
864例患者中，19例（2.2%）发生上尿路尿路上皮癌复发。在这19例患者中，通过常规成像检测到复发的有12例（63.2%），通过膀胱镜检查检测到的有2例（10.5%），通过尿细胞学检查检测到的有2例（10.5%），通过肉眼血尿检测到的有1例（5.3%）。所有患者在原发性非肌层浸润性膀胱癌诊断时均为高风险或最高风险的非肌层浸润性膀胱癌。多因素Fine-Gray比例回归分析显示，肿瘤大小≥30 mm和原位癌与上尿路尿路上皮癌无复发生存期缩短独立相关（分别为=0.040和0.0089）。
大多数发生上尿路尿路上皮癌复发的患者是通过常规监测成像诊断出来的，这表明其临床重要性，特别是对于伴有肿瘤大小≥30 mm和原位癌的非肌层浸润性膀胱癌患者。
