Allard P, Bernard P, Fradet Y, Têtu B
Department of Social and Preventive Medicine, Laval University, Quebec City, Province of Quebec, Canada.
Br J Urol. 1998 May;81(5):692-8. doi: 10.1046/j.1464-410x.1998.00628.x.
To develop a simple prognostic index for anticipating more precisely the early clinical course of primary superficial bladder cancer.
The prognostic value of patient and tumour characteristics was examined in 333 patients with primary Ta or T1 bladder cancer who participated in a multicentre prospective study already completed. Primary tumour multiplicity, a diameter of > 3 cm, stage T1, and grade 2 or 3 were independent predictors of earlier recurrence in a multivariate analysis. A simplified prognostic index consisted of the number of adverse tumour characteristics (ATCs) initially present.
After a median follow-up of 35.3 months, the 60 patients free of ATCs (19%) had a recurrence-free probability at 12 and 24 months of 86% and 69%, respectively, and none experienced progression. Recurrence outcomes deteriorated consistently as the number of ATCs increased among the other three groups. In patients with 3-4 ATCs, the 12- and 24-month recurrence-free probability was as low as 30% and 19%, and recurrence and tumour rates were about 2.6 times higher than in patients free of ATCs; 7% of these patients experienced progression within 35 months of follow-up.
A prognostic index based on the number of ATCs (primary tumour multiplicity, diameter > 3 cm, stage T1, and grade 2 or 3) is a strong indicator of the clinical course of superficial bladder cancer within 3 years of the first endoscopic resection. This proposal is suggested for discussion and for validation in future studies but if confirmed, this simple prognostic index may greatly help to identify indicators for adjuvant intravesical therapy and to determine the optimal periodicity of control cystoscopy regimens.
开发一种简单的预后指数，以更精确地预测原发性浅表性膀胱癌的早期临床病程。
在333例原发性Ta或T1期膀胱癌患者中检验患者和肿瘤特征的预后价值，这些患者参与了一项已完成的多中心前瞻性研究。在多变量分析中，原发性肿瘤多发、直径>3 cm、T1期以及2级或3级是早期复发的独立预测因素。一种简化的预后指数由最初存在的不良肿瘤特征（ATC）数量组成。
中位随访35.3个月后，60例无ATC的患者（19%）在12个月和24个月时无复发概率分别为86%和69%，且无进展情况。在其他三组中，随着ATC数量增加，复发结局持续恶化。在有3 - 4个ATC的患者中，12个月和24个月时无复发概率低至30%和19%，复发率和肿瘤进展率比无ATC的患者高约2.6倍；这些患者中有7%在随访35个月内出现进展。
基于ATC数量（原发性肿瘤多发、直径>3 cm、T1期以及2级或3级）的预后指数是首次内镜切除后3年内浅表性膀胱癌临床病程的有力指标。本提议供讨论及未来研究验证，但如果得到证实，这种简单的预后指数可能极大地有助于确定辅助膀胱内治疗的指标，并确定控制膀胱镜检查方案的最佳周期。
