Häggström Christel, Hagberg Oskar, Holmberg Lars, Hosseini Abolfazl, Jerlström Tomas, Ströck Viveka, Söderkvist Karin, Ullén Anders, Liedberg Fredrik, Jahnson Staffan, Aljabery Firas
Department of Surgical Sciences Uppsala University Uppsala Sweden.
Northern Registry Centre, Department of Diagnostics and Intervention, Oncology Umeå University Umeå Sweden.
BJUI Compass. 2025 May 5;6(5):e70021. doi: 10.1002/bco2.70021. eCollection 2025 May.
To investigate the risk of upper urinary tract urothelial carcinoma (UTUC) in patients with non-muscle-invasive bladder cancer (NMIBC), in relation to the primary NMIBC tumour risk categories, calendar time trends and intravesical Bacillus Calmette-Guerin (BCG) treatment.
All patients with primary NMIBC diagnosed 1997-2019 registered in Bladder Cancer Data base Sweden (BladderBaSe) 2.0 were included in the study. Risk of UTUC was calculated by cumulative incidence proportion using competing risk analysis. Associations with risk of UTUC by tumour stage category, calendar time, and intravesical BCG treatment was estimated by hazard ratios from multivariable Cox regression analyses.
Of 36 038 NMIBC patients, 537 (1.5%) were diagnosed with UTUC during a mean time of 7 years in follow-up. The risk of UTUC within 10 years from NMIBC diagnosis was 1.7% (95% 1.6-1.9) with highest estimates for TaG3/CIS. Stage T1 and TaG3/CIS, as compared with TaG1-2 was associated to risk, with stronger associations during later calendar times. Within high-risk NMIBC patients (CIS/TaG3/T1), intravesical BCG treatment was associated with higher risk of UTUC.
This large study of more than 36 000 patients with NMIBC found 1.7% (95% 1.6-1.9) risk of UTUC within 10 years of diagnosis. Differences by tumour stage category indicate the need for refined studies accounting for tumour characteristics, location in the bladder and given treatment to optimise follow-up routines in NMIBC.
探讨非肌层浸润性膀胱癌（NMIBC）患者发生上尿路尿路上皮癌（UTUC）的风险，及其与原发性NMIBC肿瘤风险类别、日历时间趋势和膀胱内卡介苗（BCG）治疗的关系。
本研究纳入了1997年至2019年在瑞典膀胱癌数据库（BladderBaSe）2.0中登记的所有原发性NMIBC患者。采用竞争风险分析，通过累积发病率比例计算UTUC的风险。通过多变量Cox回归分析的风险比，评估肿瘤分期类别、日历时间和膀胱内BCG治疗与UTUC风险的关联。
在36038例NMIBC患者中，537例（1.5%）在平均7年的随访期间被诊断为UTUC。NMIBC诊断后10年内UTUC的风险为1.7%（95% 1.6 - 1.9），TaG3/CIS的估计风险最高。与TaG1 - 2相比，T1期和TaG3/CIS与风险相关，在较晚的日历时间关联更强。在高危NMIBC患者（CIS/TaG3/T1）中，膀胱内BCG治疗与UTUC的较高风险相关。
这项对超过36000例NMIBC患者的大型研究发现，诊断后10年内UTUC的风险为1.7%（95% 1.6 - 1.9）。肿瘤分期类别的差异表明，需要进行更精细的研究，考虑肿瘤特征、膀胱位置和给定的治疗方法，以优化NMIBC的随访程序。
