Kiemeney L A, Witjes J A, Heijbroek R P, Debruyne F M, Verbeek A L
Department of Epidemiology, University of Nijmegen, The Netherlands.
Eur J Cancer. 1994;30A(11):1621-5. doi: 10.1016/0959-8049(94)e0133-o.
Random urothelium biopsies were taken at initial endoscopic surgery from 1001 patients with primary superficial bladder cancer. The clinical course of all the patients was assessed prospectively. Actuarial risks of recurrence and disease progression were determined for prognostic characteristics and comparisons were made using log-rank tests. The independent prognostic significance of concomitant intra-aurothelial dysplastic changes was examined with Cox's regression analyses. The 3-year risk of recurrence in patients with dysplasia and carcinoma in situ (CIS) in macroscopically normal-looking urothelium was only slightly higher than the risk in patients without dysplastic changes (56, 58 and 51%, respectively; P = 0.25). Concomitant dysplasia or CIS significantly increased the 3-year risk of disease progression (17 and 31%, respectively, versus 7%; P < 0.001). After adjustment for the effects of age, tumour stage, grade, size and multicentricity, the result of random biopsies had no prognostic significance regarding the risk of recurrence, but the detection of dysplasia or CIS increased the risk of progression by approximately 80%. This result suggests that random urothelium biopsies may be useful as an additional guide in defining therapy in primary superficial bladder cancer.
在初次内镜手术时，对1001例原发性浅表性膀胱癌患者进行了随机尿路上皮活检。对所有患者的临床病程进行了前瞻性评估。根据预后特征确定复发和疾病进展的精算风险，并使用对数秩检验进行比较。采用Cox回归分析检验了伴随的尿路上皮内发育异常改变的独立预后意义。在肉眼外观正常的尿路上皮中，发育异常和原位癌（CIS）患者的3年复发风险仅略高于无发育异常改变的患者（分别为56%、58%和51%；P = 0.25）。伴随的发育异常或CIS显著增加了3年疾病进展风险（分别为17%和31%，而无发育异常改变的患者为7%；P < 0.001）。在调整年龄、肿瘤分期、分级、大小和多中心性的影响后，随机活检结果对复发风险没有预后意义，但发育异常或CIS的检测使进展风险增加了约80%。这一结果表明，随机尿路上皮活检可能有助于作为确定原发性浅表性膀胱癌治疗方案的额外指导。
