局限性膀胱癌患者按T分期的生存率：对未来筛查试验的启示
Survival by T Stage for Patients with Localized Bladder Cancer: Implications for Future Screening Trials.
作者信息
Folgosa Cooley Lauren, Weiner Adam B, Meng Xiaosong, Woldu Solomon L, Meeks Joshua J, Lotan Yair
机构信息
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
出版信息
Bladder Cancer. 2021 Mar 19;7(1):23-31. doi: 10.3233/BLC-200381. eCollection 2021.
BACKGROUND
There is insufficient data to recommend screening for bladder cancer (BC). For future BC screening trials, it is important to understand how and if tumor (T) stage can act as a surrogate outcome marker for overall (OS) and cancer-specific (CSS) survival.
OBJECTIVE
To characterize OS and CSS between primary tumor (T) stages in non-metastatic bladder cancer (BC) patients.
METHODS
Non-metastatic BC patients were identified in the National Cancer Database (NCDB; 2004-2015) (n = 343,163) and National Cancer Institute Surveillance, Epidemiology, and End Results database (SEER) (n = 130,751). Cox multivariable regression compared relationships between T stage (LGTa, HGTa, Tis, LGT1, HGT1, T2-T4) and OS or CSS for all patients and sub-cohorts.
RESULTS
Compared to stage LGTa as a reference, overall (SEER; NCDB) and cancer-specific (SEER) survival significantly declined with increasing T stage. Using SEER, OS ranged from HGTa (HR 1.16, CI 1.13-1.21, < 0.001) to T4 (HR 5.70, CI 5.41-6.00, < 0.001) with a steep inflection between HGT1 (HR 1.68, CI 1.63-1.73, < 0.001) and T2 (HR 3.39, CI 3.30-3.49, < 0.001), which was verified with NCDB. The association of stage and CSS was even more pronounced: HGTa (84% 10 year-CSS, HR 1.94, CI 1.81-2.08, < 0.001), Tis (82% 10 year-CSS, HR 2.28, CI 2.09-2.47, < 0.001), LGT1 (84% 10 year-CSS, HR 2.30, CI 2.11-2.51, < 0.001), HGT1 (72% 10 year-CSS, HR 4.24, CI 4.01-4.47, < 0.001), T2 (48% 10 year-CSS, HR 12.18, CI 11.57-12.82, < 0.001), T3 (45% 10 year-CSS, HR 14.60, CI 13.63-15.64, < 0.001), and T4 (29% 10 year-CSS, HR 22.76, CI 21.19-24.44, < 0.001).
CONCLUSIONS
Earlier T stage at diagnosis was associated with better OS largely due to differences in CSS. A clinically significant difference between Stage I and Stage II was verified herein in multiple cohorts. Therefore, earlier stage at diagnosis, specifically preventing muscle invasive BC, could potentially improve survival.
背景
目前尚无足够数据推荐进行膀胱癌（BC）筛查。对于未来的BC筛查试验，了解肿瘤（T）分期如何以及是否可作为总生存期（OS）和癌症特异性生存期（CSS）的替代结局标志物非常重要。
目的
描述非转移性膀胱癌（BC）患者原发肿瘤（T）分期之间的OS和CSS。
方法
在国家癌症数据库（NCDB；2004 - 2015年）（n = 343,163）和美国国立癌症研究所监测、流行病学和最终结果数据库（SEER）（n = 130,751）中识别非转移性BC患者。Cox多变量回归比较了所有患者和亚组队列中T分期（低危Ta期、高危Ta期、Tis期、低危T1期、高危T1期、T2 - T4期）与OS或CSS之间的关系。
结果
与低危Ta期作为参照相比，随着T分期增加，总生存期（SEER；NCDB）和癌症特异性生存期（SEER）显著下降。使用SEER数据，OS范围从高危Ta期（HR 1.16，CI 1.13 - 1.21，<0.001）到T4期（HR 5.70，CI 5.41 - 6.00，<0.001），在高危T1期（HR 1.68, CI 1.63 - 1.73, <0.001）和T2期（HR 3.39, CI 3.30 - 3.49, <0.001）之间有一个陡峭的转折点，这在NCDB中得到了验证。分期与CSS之间的关联更为明显：高危Ta期（10年CSS为84%，HR 1.94，CI 1.81 - 2.08，<0.001）、Tis期（10年CSS为82%，HR 2.28，CI 2.09 - 2.47，<0.001）、低危T1期（10年CSS为84%，HR 2.30，CI 2.11 - 2.51，<0.001）、高危T1期（10年CSS为72%，HR 4.24，CI 4.01 - 4.47，<0.001）、T2期（10年CSS为48%，HR 12.18，CI 11.57 - 12.82，<0.001）、T3期（10年CSS为45%，HR 14.60，CI 13.63 - 15.64，<0.001）和T4期（10年CSS为29%，HR 22.76，CI 21.19 - 24.44，<0.001）。
结论
诊断时较早的T分期与较好的OS相关，主要是由于CSS的差异。本文在多个队列中验证了I期和II期之间具有临床意义的差异。因此，诊断时较早的分期，特别是预防肌肉浸润性BC，可能会改善生存期。
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