Female Gender and Carcinoma In Situ in the Prostatic Urethra Are Prognostic Factors for Recurrence, Progression, and Disease-Specific Mortality in T1G3 Bladder Cancer Patients Treated With Bacillus Calmette-Guerin
Female Gender and Carcinoma In Situ in the Prostatic Urethra Are Prognostic Factors for Recurrence, Progression, and Disease-Specific Mortality in T1G3 Bladder Cancer Patients Treated With Bacillus Calmette-Guerin
复制标题
DOI：
10.1016/j.eururo.2011.10.029
复制
发表时间：
2012-07-01
期刊：
影响因子：
23.4
通讯作者：
Villavicencio, Humberto
中科院分区：
文献类型：
--
作者：
Palou, Joan;Sylvester, Richard J.;Villavicencio, Humberto
背景：T1级非肌浸润性膀胱癌（NMIBC）患者接受卡介苗（BCG）治疗后最重要的预后因素存在争议。目的：评估T1G3型NMIBC患者经辅助膀胱内卡介苗免疫治疗后复发、进展和疾病特异性死亡率的预后因素及长期随访。设计、环境和参与者：对146例原发性T1G3期NMIBC患者进行单机构回顾性分析。干预：所有患者均行经尿道全切除术（TUR）加包括前列腺尿道在内的多次膀胱活检。没有做第二次旋转。患者在没有维持治疗的情况下接受膀胱内卡介苗（Connaught株，81 mg）诱导疗程。测量方法：分析膀胱癌（BCa）复发、进展和死亡的时间变量为性别、年龄、肿瘤多样性、直径、部位、亚分期、合并原位癌（CIS）和前列腺尿道CIS。使用Cox回归模型评估这些因素的单因素和多因素预后重要性，并估计风险比（hr）。使用累积关联函数估计时间到事件的分布。结果和局限性：中位随访时间为8.7年。65例（44.5%）患者复发，25例（17.1%）患者进展，18例（12.3%）患者死于BCa。女性和前列腺尿道CIS的存在与BCa复发（p = 0.0003, HR: 2.53）、进展（p = 0.001, HR: 3.59）和死亡（p = 0.004, HR: 3.53）的风险增加相关。结论：在诱导BCG治疗的原发性T1G3膀胱肿瘤中，女性或前列腺尿道中存在CIS是影响复发时间、进展和疾病相关死亡率的唯一预后因素。对原发性高级别NMIBC患者进行前列腺尿道活检作为获得预后信息的第一步是非常重要的。(C) 2011年由Elsevier B.V.代表欧洲泌尿外科协会出版。
Background: Controversy exists over the most important prognostic factors in T1 high-grade non-muscle-invasive bladder cancer (NMIBC) patients treated with bacillus Calmette-Guerin (BCG).Objective: Evaluate prognostic factors for recurrence, progression, and disease-specific mortality after adjuvant intravesical BCG immunotherapy in patients with T1G3 NMIBC and long-term follow-up.Design, setting, and participants: A single-institution retrospective analysis of 146 patients with primary stage T1G3 NMIBC.Intervention: All patients were treated with complete transurethral resection (TUR) plus multiple bladder biopsies that included the prostatic urethra. No second TUR was done. Patients underwent an induction course of intravesical BCG (Connaught strain, 81 mg) without maintenance therapy.Measurements: The variables analysed for time to recurrence, progression, and death due to bladder cancer (BCa) were gender, age, tumour multiplicity, diameter, aspect, substaging, concomitant carcinoma in situ (CIS), and CIS in the prostatic urethra. Cox regression models were used to assess the univariate and multivariate prognostic importance of these factors and estimate hazard ratios (HRs). Time-to-event distributions were estimated using cumulative incidence functions.Results and limitations: The median follow-up was 8.7 yr. Sixty-five patients (44.5%) had recurrence, 25 patients (17.1%) had progression, and 18 patients (12.3%) died because of BCa. Female gender and presence of CIS in the prostatic urethra were associated with an increased risk of recurrence (p = 0.0003, HR: 2.53), progression (p = 0.001, HR: 3.59), and death due to BCa (p = 0.004, HR: 3.53).Conclusions: In primary T1G3 bladder tumours treated with induction BCG, female gender or having CIS in the prostatic urethra were the only prognostic factors for time to recurrence, progression, and disease-related mortality. It is very important to perform a biopsy of the prostatic urethra in patients with primary high-grade NMIBC as a first step to obtain this prognostic information. (C) 2011 Published by Elsevier B.V. on behalf of European Association of Urology.