一种针对接受年度监测的患者，使用膀胱Cx的新型膀胱癌监测方案。
A novel bladder cancer surveillance schedule using bladder Cx for patients on annual surveillance.
作者信息
Guduguntla Arjun, Whish-Wilson Thomas, Chandler Lauren, Gyomber Dennis
机构信息
Department of Urology Northern Health Victoria Australia.
University of Melbourne Victoria Australia.
出版信息
BJUI Compass. 2025 Jan 15;6(1):e468. doi: 10.1002/bco2.468. eCollection 2025 Jan.
OBJECTIVES
Cx bladder monitor (CxM) is a urine test with a proven high sensitivity and negative predictive value in bladder cancer surveillance. The aim of this retrospective study was to report on the outcomes of our newly implemented bladder cancer surveillance program for patients eligible for yearly cystoscopy, as per the European Association of Urology (EAU) guidelines. In this program, eligible patients alternate between yearly surveillance cystoscopy and CxM, instead of the standard yearly surveillance cystoscopy. Outcomes measures were overall results of CxM and subsequent treatment patterns of patients, impact on waiting lists, cost comparison and patient satisfaction.
PATIENTS AND METHODS
In 2022, 109 eligible and consenting patients were identified, with 98 commencing on the new surveillance program, starting with CxM instead of cystoscopy. A negative CxM, would result in a planned flexible cystoscopy in 12 months. If a patient had a positive CxM, they proceeded to undergo a cystoscopy, and if required, imaging.
RESULTS
Of the 98 that underwent testing, 90 had a negative CxM test and 8 patients had a positive CxM test. Three of these eight were true positive (PPV 0.375). Seventy negative CxM patients had no recurrence at the time of the next cystoscopy/imaging. Of the remaining 20 negative CxM patients, 11 were found to have a recurrence at subsequent cystoscopy/imaging and 9 did not proceed with further surveillance for various reasons. All of the tumour recurrences diagnosed after a negative CxM were non-invasive, thus there was no progression to muscle-invasive disease. All suitable patients consented to continuing with the CxM protocol. The hospital surveillance cystoscopy waitlist was reduced by approximately 59% and CxM was approximately $850 AUD cheaper than a cystoscopy.
CONCLUSION
CxM can be safely used in an alternating schedule with Flexible Cystoscopy for patients on annual bladder cancer surveillance.
目的
Cx膀胱监测仪（CxM）是一种尿液检测方法，在膀胱癌监测中已被证明具有高灵敏度和阴性预测值。这项回顾性研究的目的是报告我们根据欧洲泌尿外科学会（EAU）指南为符合每年进行膀胱镜检查条件的患者新实施的膀胱癌监测项目的结果。在该项目中，符合条件的患者在每年的监测膀胱镜检查和CxM之间交替进行，而不是标准的每年监测膀胱镜检查。结果指标包括CxM的总体结果和患者随后的治疗模式、对等候名单的影响、成本比较和患者满意度。
患者与方法
2022年，确定了109名符合条件并同意参与的患者，其中98名开始了新的监测项目，从CxM而非膀胱镜检查开始。CxM结果为阴性的患者，计划在12个月后进行软性膀胱镜检查。如果患者CxM结果为阳性，则进行膀胱镜检查，必要时进行影像学检查。
结果
在接受检测的98名患者中，90名CxM检测结果为阴性，8名患者CxM检测结果为阳性。这8名患者中有3名是真正的阳性（阳性预测值为0.375）。70名CxM结果为阴性的患者在下一次膀胱镜检查/影像学检查时未复发。在其余20名CxM结果为阴性的患者中，11名在随后的膀胱镜检查/影像学检查中发现复发，9名因各种原因未继续进行进一步监测。所有在CxM结果为阴性后诊断出的肿瘤复发均为非侵袭性，因此没有进展为肌层浸润性疾病。所有合适的患者都同意继续采用CxM方案。医院监测膀胱镜检查的等候名单减少了约59%，CxM比膀胱镜检查便宜约850澳元。
结论
对于接受年度膀胱癌监测的患者，CxM可与软性膀胱镜检查安全地交替使用。
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