Implications of Guideline-based, Risk-stratified Restaging Transurethral Resection of High-grade Ta Urothelial Carcinoma on Bacillus Calmette-Guérin Therapy Outcomes.
Implications of Guideline-based, Risk-stratified Restaging Transurethral Resection of High-grade Ta Urothelial Carcinoma on Bacillus Calmette-Guérin Therapy Outcomes.
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基于准则的，风险分层的静脉尿道切除型尿路上皮癌对芽孢杆菌的calmette-guérin治疗结果的含义。
DOI：
10.1016/j.euo.2021.04.003
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发表时间：
2022-06
影响因子：
8.2
通讯作者：
Kamat AM
中科院分区：
文献类型：
--
作者：
Hensley PJ;Bree KK;Brooks N;Matulay J;Li R;Nogueras-Gonzalez GM;Nagaraju S;Navai N;Grossman HB;Dinney CP;Kamat AM
由于缺乏数据，高级别（HG）Ta膀胱肿瘤再分期经尿道切除术（reTUR）的指南适应症各不相同。研究基于指南的风险适应性方法，以重新TUR治疗HG Ta病变。对2000年至2019年接受适当卡介苗（BCG）的原发性HG Ta患者进行了机构审查。使用reTUR的指南标准对患者进行分层。Kaplan-Meier乘积限制估计生存期。考克斯回归和对数秩检验确定了变量与生存率的相关性。在209例HG Ta膀胱癌患者中，104例（50%）接受了reTUR，其中39例患者（38%）发现了残留病变。仅1例患者（1%）在reTUR时提前至pT 1。在所有未分层的HG Ta患者中，reTUR与改善的无进展生存期（p = 0.050）和无复发生存期（RFS; p = 0.003）相关。根据AUA指南，接受与未接受reTUR的患者的5年RFS分别为73%（95%置信区间63-81%）与52%（40-62%），根据EAU指南，接受与未接受reTUR的患者的5年RFS分别为76%（61-86%）与22%（4-49%）。在45例同时符合AUA高风险标准（大的多灶性肿瘤）和EAU标准（缺乏逼尿肌）的患者中，缺乏再分期与复发（67% vs 15%，p = 0.002）和进展（25% vs 6%，p = 0.109）增加2倍以上相关。在选择reTUR候选人时，数据受到选择偏倚的限制。在所有HG Ta患者中，无论危险分层如何，TUR重新分期均与结局改善相关。reTUR的受益在索引标本中没有肌肉的高风险患者中最为显著，与AUA和EAU指南的组成部分一致。这些数据支持对所有HG Ta病变采用非风险适应性方法进行reTUR。膀胱肿瘤切除术的重新分期改善了接受卡介苗（BCG）治疗的高级别Ta肿瘤患者的结局。
Guideline indications for restaging transurethral resection (reTUR) for high-grade (HG) Ta bladder tumors vary due to a paucity of data. To investigate guideline-based, risk-adapted approaches to reTUR for HG Ta lesions. An institutional review of primary HG Ta patients who received adequate bacillus Calmette-Guérin (BCG) from 2000 to 2019 was conducted. Guideline criteria for reTUR were used to stratify patients. Kaplan-Meier product limits estimated survival. Cox regression and log-rank tests identified association of variables with survival. Of the 209 patients with HG Ta bladder cancer, 104 (50%) underwent reTUR, which identified residual disease in 39 patients (38%). Only one patient (1%) was upstaged to pT1 on reTUR. In all unstratified HG Ta patients, reTUR was associated with improved progression-free survival (p = 0.050) and recurrence-free survival (RFS; p = 0.003). The 5-yr RFS for patients who underwent versus those who did not undergo reTUR based on AUA guidelines was 73% (95% confidence interval 63–81%) versus 52% (40–62%), and for those who underwent versus those who did not undergo reTUR based on EAU guidelines was 76% (61–86%) versus 22% (4–49%). In 45 patients meeting both AUA high-risk criteria (large, multifocal tumors) and EAU criteria (lack of detrusor muscle), lack of restaging was associated with over a two-fold increase in recurrence (67% vs 15%, p = 0.002) and progression (25% vs 6%, p = 0.109). Data were limited by selection bias unaccounted for in selecting candidates for reTUR. Restaging TUR in all HG Ta patients, regardless of risk stratification, was associated with improved outcomes. The benefit of reTUR was most notable in high-risk patients without muscle in the index specimen, consistent with components of both AUA and EAU guidelines. These data support a non–risk-adapted approach to reTUR for all HG Ta lesions. Restaging bladder tumor resection improves outcomes in patients with high-grade Ta tumors treated with bacillus Calmette-Guérin (BCG).
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影响因子：
6.6
作者：
Herr, Harry W.;Donat, S. Machele;Dalbagni, Guido
通讯作者：
Dalbagni, Guido
影响因子：
6.6
作者：
Grimm, MO;Steinhoff, C;Vögeli, TA
通讯作者：
Vögeli, TA
影响因子：
2.1
作者：
Tobert, Conrad M.;Nepple, Kenneth G.;Erickson, Bradley A.
通讯作者：
Erickson, Bradley A.
影响因子：
6.6
作者：
Chang, Sam S.;Boorjian, Stephen A.;McKiernan, James M.
通讯作者：
McKiernan, James M.
影响因子：
23.4
作者：
Brausi, M;Collette, L;Sylvester, RJ
通讯作者：
Sylvester, RJ