Li Yajun, Sun Xiaoyu, Wang Yue, Ma Baojie, Quan Changyi
Department of Urologic Surgery, The Second Hospital of Tianjin Medical University, Tianjin, China.
Int Urol Nephrol. 2025 Feb 1. doi: 10.1007/s11255-025-04391-8.
To evaluate the long-term treatment outcomes of T1 high-grade (T1HG) urothelial carcinoma (UCB) with lymphovascular invasion (LVI).
We retrospectively analyzed the data of 70 patients of T1HG UCB with LVI who were treated at the Second Hospital of Tianjin Medical University between 2009 and 2019. The log rank test and Cox regression analyses were performed to identify factors that predict the recurrence and survival of these "highest risk" group of non-muscle invasive bladder cancer (NMIBC).
With a median follow-up of 46.0 months (range 2-151), the 5-year overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS) and progression-free survival (PFS) rates were 65%, 78%, 28% and 56% after trans-urethral resection of bladder tumor (TURBT), and 35%, 48%, 35% and 35% after radical cystectomy (RC), respectively. Treatment modality (tumor burden) was and independent predictor of OS (Hazard ratios (HRs) 2.176, 95% confidence intervals (CIs) 1.021-4.637, p = 0.044) and CSS (HRs 3.675, CIs 1.311-10.297, p = 0.013), and was weakly associated with RFS (HRs 0.560, CIs 0.281-1.114, p = 0.099). A history of urothelial carcinoma of the bladder (H.UCB) was an independent predictor of RFS (HRs 2.246, CIs 1.102-4.579, p = 0.026) and PFS (HRs 2.259, CIs 1.036-4.927, p = 0.041). Tumor size was an independent predictor of RFS (HRs 2.093, CIs 1.054-4.159, p = 0.035).
In T1HG UCB with LVI, tumor burden was a significant predictor of survival. Radical cystectomy should be individualized and not universally recommended. Recurrent T1HG UCB with LVI potentially represents a sign of progression, and RC regardless of tumor burden might be a reasonable alternative for this subgroup of patients.
评估伴有淋巴管侵犯（LVI）的T1期高级别（T1HG）尿路上皮癌（UCB）的长期治疗效果。
我们回顾性分析了2009年至2019年在天津医科大学第二医院接受治疗的70例伴有LVI的T1HG UCB患者的数据。进行对数秩检验和Cox回归分析，以确定预测这些“最高风险”组非肌层浸润性膀胱癌（NMIBC）复发和生存的因素。
中位随访时间为46.0个月（范围2 - 151个月），经尿道膀胱肿瘤切除术（TURBT）后5年总生存（OS）率、癌症特异性生存（CSS）率、无复发生存（RFS）率和无进展生存（PFS）率分别为65%、78%、28%和56%，根治性膀胱切除术（RC）后分别为35%、48%、35%和35%。治疗方式（肿瘤负荷）是OS（风险比（HRs）2.176，95%置信区间（CIs）1.021 - 4.637，p = 0.044）和CSS（HRs 3.675，CIs 1.311 - 10.297，p = 0.013）的独立预测因素，与RFS弱相关（HRs 0.560，CIs 0.281 - 1.114，p = 0.099）。膀胱尿路上皮癌病史（H.UCB）是RFS（HRs 2.246，CIs 1.102 - 4.579，p = 0.026）和PFS（HRs 2.259，CIs 1.036 - 4.927，p = 0.041）的独立预测因素。肿瘤大小是RFS的独立预测因素（HRs 2.093，CIs 1.054 - 4.159，p = 0.035）。
在伴有LVI的T1HG UCB中，肿瘤负荷是生存的重要预测因素。根治性膀胱切除术应个体化，而非普遍推荐。复发的伴有LVI的T1HG UCB可能代表疾病进展的迹象，对于该亚组患者，无论肿瘤负荷如何，RC可能是一种合理的选择。
