Role of Previous Malignancy History in Clinical Outcomes in Patients with Initially Diagnosed Non-Muscle Invasive Bladder Cancer
Role of Previous Malignancy History in Clinical Outcomes in Patients with Initially Diagnosed Non-Muscle Invasive Bladder Cancer
复制标题
DOI：
10.1245/s10434-021-09750-0
复制
发表时间：
2021-03-05
影响因子：
3.7
通讯作者：
Oya, Mototsugu
中科院分区：
文献类型：
--
作者：
Kufukihara, Ryohei;Kikuchi, Eiji;Oya, Mototsugu
导论.我们的目的是评估既往非尿路上皮恶性肿瘤史是否影响非肌层浸润性膀胱癌（NMIBC）患者的临床结局。我们确定了1999年至2017年期间在我们的四个机构中通过经尿道膀胱肿瘤切除术治疗最初诊断为NMIBC的1097例病例。我们比较了有和无既往非尿路上皮恶性肿瘤病史的NMIBC患者的临床特征和结局，并调查了吸烟状况和既往癌症治疗方式是否影响NMIBC的结局。共有177例患者（16.1%）既往有非尿路上皮恶性病史（恶性病史组）。恶性史组的5年无复发生存率和5年无进展生存率分别为46.4%和88.3%，显著低于对照组（分别为60.2% p = 0.004和94.5% p = 0.002）。多变量考克斯回归分析表明，既往非尿路上皮恶性肿瘤史是肿瘤复发（p = 0.001）和分期进展（p = 0.003）的独立危险因素。在目前吸烟的患者亚组（N = 347）中，既往非尿路上皮恶性肿瘤史与肿瘤复发和分期进展相关。相反，既往非尿路上皮恶性肿瘤史与既往吸烟者或非吸烟者的肿瘤复发或分期进展无关。在既往有前列腺癌病史的NMIBC患者的亚组分析中，接受雄激素剥夺治疗的患者膀胱肿瘤复发率显著低于其对应者（p = 0.027）。既往非尿路上皮恶性肿瘤史可能导致NMIBC患者（尤其是当前吸烟者）的临床结局更差。
Introduction. Our aim is to evaluate whether previous non-urothelial malignant history affects the clinical outcomes of patients with non-muscle invasive bladder cancer (NMIBC).Patients and Methods. We identified 1097 cases treated by transurethral resection of bladder tumors for initially diagnosed NMIBC at our four institutions between 1999 and 2017. We compared clinical characteristics and outcomes between NMIBC patients with and without previous non-urothelial malignant history and investigated whether smoking status and treatment modality for previous cancer affected NMIBC outcomes.Results. A total of 177 patients (16.1%) had previous non-urothelial malignant history (malignant history group). The 5-year recurrence-free survival rate and the 5-year progression-free survival rate in the malignant history group was 46.4% and 88.3%, respectively, which was significantly lower than that in the counterpart (60.2% p = 0.004, and 94.5% p = 0.002, respectively). A multivariate Cox regression analysis identified previous non-urothelial malignant history as an independent risk factor for tumor recurrence (p = 0.001) and stage progression (p = 0.003). In a subgroup of patients who were current smokers (N = 347), previous non-urothelial malignant history was associated with tumor recurrence and stage progression. In contrast, previous non-urothelial malignant history was not associated with tumor recurrence or stage progression in ex-smokers or non-smokers. In a subgroup analysis of NMIBC patients with previous prostate cancer history, those treated with androgen deprivation therapy had a significantly lower bladder tumor recurrence rate than their counterparts (p = 0.027).Conclusions. Previous history of non-urothelial malignancy may lead to worse clinical outcome in patients with NMIBC, particularly current smokers.