Guideline adherence for radical cystectomy significantly affects survival outcomes in non-muscle-invasive bladder cancer patients
Guideline adherence for radical cystectomy significantly affects survival outcomes in non-muscle-invasive bladder cancer patients
复制标题
根治性膀胱切除术指南的遵守显着影响非肌层浸润性膀胱癌患者的生存结果
DOI：
10.1093/jjco/hyab060
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发表时间：
2021
影响因子：
2.4
通讯作者：
Oya Mototsugu
中科院分区：
文献类型：
--
作者：
Kayama Emina;Shigeta Keisuke;Kikuchi Eiji;Ogihara Koichiro;Hakozaki Kyohei;Iwasawa Tomohiro;Kamisawa Ken;Kanai Kunimitsu;Ide Hiroki;Hara Satoshi;Mizuno Ryuichi;Oya Mototsugu
背景：非肌肉浸润性膀胱癌根治性膀胱切除术的指南依从性与患者预后的关系目前尚不清楚。我们调查了非肌肉侵袭性膀胱癌患者接受根治性膀胱切除术时的指南依从性是否会影响膀胱癌患者的肿瘤预后。方法267例cTa-4N0-2M0膀胱癌患者中，70例在非肌肉浸润性膀胱癌或非肌肉浸润性膀胱癌进展为肌肉浸润性膀胱癌的情况下行根治性膀胱切除术。从最初经尿道膀胱肿瘤切除术到根治性膀胱切除术的患者被定义为指南依从组（n= 52），未遵循指南的患者被定义为指南非依从组（n= 18）。结果在指南非依从组中，18例卡尔梅特芽孢杆菌Guérin-naïve患者中有8例（44.4%）被诊断为高危非肌浸润性膀胱癌，7例（38.9%）被诊断为卡尔梅特芽孢杆菌谷氨酰胺无反应状态。指南非依从组与指南依从组的5年无复发生存率和癌症特异性生存率分别为38.9%对69.8% （P= 0.018）和52.7%对80.1% （P= 0.006）。多变量分析发现，不遵守指南是疾病复发（危险比= 2.81，P= 0.008）和癌症特异性死亡（危险比= 4.04，P= 0.003）的独立指标之一。在49例根治性膀胱切除术时cT1或更小的非肌肉浸润性膀胱癌患者的亚组分析中，指南不依从性仍然是癌症特异性生存的独立预后因素（风险比= 3.46，P= 0.027）。结论在非肌肉浸润性膀胱癌的时间过程中，遵循指南可能会导致接受根治性膀胱切除术的患者预后良好。即使在非肌肉浸润性膀胱癌状态下，根治性膀胱切除术也需要在指南建议的适当时机进行。
BackgroundThe relationship between guideline adherence for radical cystectomy of non-muscle-invasive bladder cancer and patient prognoses currently remains unclear. We investigated whether guideline adherence at the time of non-muscle-invasive bladder cancer affects the oncological outcomes of bladder cancer patients who underwent radical cystectomy.MethodsAmong 267 cTa-4N0-2M0 bladder cancer patients, 70 who underwent radical cystectomy under the non-muscle-invasive bladder cancer or muscle-invasive bladder cancer status that progressed from non-muscle-invasive bladder cancer were identified. Patients who followed the guidelines from initial transurethral resection of bladder tumors to radical cystectomy were defined as the guideline adherent group (n= 52), while those who did not were the guideline non-adherent group (n= 18).ResultsIn the guideline non-adherent group, 8 (44.4%) out of 18 were diagnosed with highest risk non-muscle-invasive bladder cancer for Bacillus Calmette Guérin-naïve patients and 7 (38.9%) had a Bacillus Calmette Guérin unresponsive tumor status. Five-year recurrence-free survival and cancer-specific survival rates for the guideline non-adherent group vs guideline adherent group were 38.9% vs 69.8% (P= 0.018) and 52.7% vs 80.1% (P= 0.006), respectively. A multivariate analysis identified guideline non-adherence as one of independent indicators for disease recurrence (hazard ratio = 2.81,P= 0.008) and cancer-specific death (hazard ratio = 4.04,P= 0.003). In a subgroup analysis of 49 patients with cT1 or less non-muscle-invasive bladder cancer at the time of radical cystectomy, guideline non-adherence remained an independent prognostic factor for cancer-specific survival (hazard ratio = 3.46,P= 0.027).ConclusionsGuideline adherence during the time course of the non-muscle-invasive bladder cancer stage may result in a favorable prognosis of patients who receive radical cystectomy. Even under non-muscle-invasive bladder cancer status, radical cystectomy needs to be performed with adequate timing under guideline recommendations.