Ta期和T1期肿瘤中分级异质性对生存影响的评估：非肌层浸润性膀胱癌队列的亚组分析
Assessment of the Impact of Grade Heterogeneity on Survival in Ta and T1 Tumors: A Subgroup Analysis of NMIBC Cohort.
作者信息
Karaburun Murat Can, Serbes Ezgi Dicle, Akpınar Çağrı, Obaid Khaled, Göğüş Cagatay, Kiremitci Saba, Enneli Duygu, Baltacı Sümer, Süer Evren
机构信息
Department of Urology, Etlik City Hospital, Ankara, Turkey; Department of Urology, Ankara University Faculty of Medicine, Ankara, Turkey.
Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey.
出版信息
Clin Genitourin Cancer. 2025 Aug;23(4):102357. doi: 10.1016/j.clgc.2025.102357. Epub 2025 Apr 14.
INTRODUCTION
We aimed to compare the RFS and PFS of Ta-MG, Ta-HG, T1-MG and T1-HG groups with the hypothesis that MG tumors may have a better prognosis than pure HG tumors.
MATERIAL AND METHODS
Patients with HG-NMIBC in the first TUR specimen between 2010 and 2020 were screened. The first TUR specimens were re-evaluated by experienced uropathologists and the percentage of LG tumor areas accompanying HG areas was determined for each case. HG tumors with accompanying LG rates ranging from 1% to 95% were evaluated as "Mixed-Grade (MG)," while tumors without any LG component (0%) were evaluated as "pure High-Grade (HG)." Survival analysis was performed using the Kaplan-Meier method. RFS and PFS were compared via the log-rank test.
RESULTS
Of the 201 patients included in the study, 25 (12.4%) had Ta-MG, 45 (22.4%) had Ta-HG, 43 (21.4%) had T1-MG and 88 (43.8%) had T1-HG tumors. The median follow-up period of the patients was 36 months. The median number of BCG instillations received by the patients was 12 and a total of 102 patients (50.7%) received a minimum of 12 doses of BCG treatment. Recurrence was observed in 6 (24%), 11 (24.4%), 13 (30.2%) and 30 (34.1%) patients in the Ta-MG, Ta-HG, T1-MG and T1-HG groups, respectively. The 36-month RFS rates were 76% (CI: 59-93), 76% (CI: 63-88), 70% (CI: 56-84) and 66% (CI: 56-76), respectively (Log-Rank; P = .701). Progression was observed in 2 (8%), 3 (6.6%), 2 (4.6%) and 19 (21.6%) patients, respectively. The 36-month PFS rates for groups were 92% (CI: 82-100), 93% (CI: 86-100), 95% (CI: 89-100) and 78% (CI: 70-87), respectively. The T1-HG group was found to have a statistically significantly lower PFS (Log-Rank; P = .016).
CONCLUSION
In BCG-treated NMIBC patients, those with T1-pure-HG tumors have worse PFS compared to those with T1-MG, Ta-HG, and Ta-MG tumors. The presence of pure-HG tumors may hold prognostic importance for NMIBC patients and might be crucial for patient classification and treatment options.
引言
我们旨在比较Ta-MG、Ta-HG、T1-MG和T1-HG组的无复发生存期（RFS）和无进展生存期（PFS），假设混合级别（MG）肿瘤的预后可能优于单纯高级别（HG）肿瘤。
材料与方法
筛选2010年至2020年间首次经尿道膀胱肿瘤切除术（TUR）标本为HG-NMIBC的患者。经验丰富的泌尿病理学家对首次TUR标本进行重新评估，并确定每例病例中HG区域伴随的低级别（LG）肿瘤区域的百分比。LG发生率在1%至95%之间的HG肿瘤被评估为“混合级别（MG）”，而无任何LG成分（0%）的肿瘤被评估为“单纯高级别（HG）”。采用Kaplan-Meier方法进行生存分析。通过对数秩检验比较RFS和PFS。
结果
该研究纳入的201例患者中，25例（12.4%）为Ta-MG，45例（22.4%）为Ta-HG，43例（21.4%）为T1-MG，88例（43.8%）为T１-HG肿瘤。患者的中位随访期为36个月。患者接受卡介苗（BCG）灌注的中位次数为12次，共有102例患者（50.7%）接受了至少12剂BCG治疗。Ta-MG、Ta-HG、T1-MG和T1-HG组分别有6例（24%）、11例（24.4%）、13例（30.2%）和30例（34.1%）患者出现复发。36个月的RFS率分别为76%（CI：59-93）、76%（CI：63-88）、70%（CI：５6-84）和66%（CI：56-76）（对数秩检验；P = 0.701）。分别有2例（8%）、3例（6.6%）、2例（4.6%）和19例（21.6%）患者出现进展。各组36个月的PFS率分别为92%（CI：82-100）、93%（CI：86-100）、95%（CI：89-100）和78%（CI：70-87）。发现T1-HG组的PFS在统计学上显著较低（对数秩检验；P = 0.016）。
结论
在接受BCG治疗的NMIBC患者中，与T1-MG、Ta-HG和Ta-MG肿瘤患者相比，T1单纯HG肿瘤患者的PFS更差。单纯HG肿瘤的存在可能对NMIBC患者的预后具有重要意义，并且可能对患者分类和治疗选择至关重要。
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