A delay in radical cystectomy of >3 months is not associated with a worse clinical outcome
A delay in radical cystectomy of >3 months is not associated with a worse clinical outcome
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DOI：
10.1111/j.1464-410x.2007.07132.x
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发表时间：
2007-11-01
影响因子：
4.5
通讯作者：
Shariat, Shahrokh F.
中科院分区：
文献类型：
--
作者：
Nielsen, Matthew E.;Palapattu, Ganesh S.;Shariat, Shahrokh F.
目的 研究从最后一次经尿道切除术 (TUR) 到根治性膀胱切除术 (RC) 的时间间隔与膀胱癌特异性结果之间的关系，因为对个体患者进行 RC 的决定很复杂，最近的报告表明从诊断到 RC 的时间间隔 > 3 个月与不良结果相关。 患者和方法 回顾了 592 名 RC 患者的记录；距上次 TUR 的间隔被分析为连续变量和分类变量（< 3 个月与 >= 3 个月）。采用逻辑回归和生存分析来评估 RC 间隔与病理特征和临床结果之间的关联。 结果 3 年和 7 年平均 (sd) 精算癌症特异性生存率分别为 70.5 (2.3)% 和 60.7 (3.2)%。总体而言，从 TUR 到 RC 的中位（范围）时间为 1.8（0.3-11.6）个月。作为连续或分类变量分析的 RC 间隔与膀胱外或淋巴结疾病、淋巴结转移、疾病复发、总体或癌症特异性生存无关。在 320 名患有临床肌肉侵袭性疾病的患者 (54%) 的亚组中，结果相似。结论这些结果表明，从最后一次 TUR 到 RC 的合理延迟与分期进展或无复发或疾病特异性生存率降低并不独立相关。这些发现可能对正在进行的新辅助治疗方案评估中的试验设计具有重要意义。尽管如此，我们认为没有理由提倡对高危膀胱癌患者及时考虑进行彻底治疗。
OBJECTIVETo examine the association between the interval from the last transurethral resection (TUR) to radical cystectomy (RC) and bladder cancer-specific outcome, as the decision to proceed to RC for an individual patient is complex, and recent reports suggest an interval from diagnosis to RC of > 3 months is associated with adverse outcomes.PATIENTS AND METHODSThe records of 592 patients who had RC were reviewed; the interval from the last TUR was analysed as both a continuous and categorical variable (< 3 vs >= 3 months). Logistic regression and survival analyses were used to evaluate the association between the interval to RC with pathological characteristics and clinical outcomes.RESULTSThe mean (sd) actuarial cancer-specific survival was 70.5 (2.3)% and 60.7 (3.2)% at 3 and 7 years, respectively. Overall, the median (range) time from TUR to RC was 1.8 (0.3-11.6) months. The interval to RC analysed as a continuous or categorical variable was not associated with extravesical or nodal disease, lymph node metastases, disease recurrence, overall or cancer-specific survival. The results were similar in the subgroup of 320 patients (54%) with clinically muscle-invasive disease.CONCLUSIONSThese results suggest that a reasonable delay from the last TUR to RC is not independently associated with stage progression or with decreased recurrence-free or disease-specific survival. These findings might have important implications for trial design in the ongoing evaluation of neoadjuvant regimens. Nevertheless, we see no reason to advocate anything less than the timely consideration of definitive treatment for patients with high-risk bladder cancer.