BCG无反抗的非肌肉侵入性膀胱癌的膀胱疗法的长期结局与根治性膀胱切除术
Long-term outcomes of bladder-sparing therapy vs radical cystectomy in BCG-unresponsive non-muscle-invasive bladder cancer
影响因子:4.40000
分区:医学2区 / 泌尿学与肾脏学2区
发表日期:2025 Feb
作者:
Jacob I Taylor, Ashish M Kamat, Michael A O'Donnell, Drupad Annapureddy, Jeffrey Howard, Wei Shen Tan, Ian McElree, Facundo Davaro, Kendrick Yim, Stephen Harrington, Elizabeth Dyer, Anna J Black, Pratik Kanabur, Mathieu Roumiguié, Seth Lerner, Peter C Black, Jay D Raman, Mark A Preston, Gary Steinberg, William Huang, Roger Li, Vignesh T Packiam, Solomon L Woldu, Yair Lotan
摘要
量化杆状杆菌菌（BCG）患者（BCG）患者的肿瘤学风险（BST） - 与预先确定的数据元素相比，与预先确定的数据元素相比，与预先确定的数据元素相比，无抑制性侵入性膀胱癌（NMIBC）与BCG的患者相比。站点。经过机构审查委员会的批准后，如果患者具有BCG无反应的NMIBC符合美国食品和药物管理标准的患者。在前期RC或BST之后收集肿瘤结果。 BST方案仅包括重新分辨或监测，重复BCG，静脉化疗，全身免疫疗法和临床试验。在578例患者中，28％接受了前期RC，72％接受了BST。中位数（四分位数）随访时间为50（20-69）月。无统计学上没有统计学的无转移生存，癌症特异性生存或治疗组之间的总生存率。在BST组中，在12和24个月时，高级复发率分别为37％和52％，在12和24个月的7％和13％中观察到了MIBC。 BST组的31.7％进行了RC，在13％中发现了淋巴结疾病，而前期RC则进行了RC（p = 0.030）。在选定的患者中，初始BST提供了与中等学期的前期RC相当的生存结果。随着时间的流逝，复发率和进展的率会增加，尤其是在接受其他BST系列治疗的患者中。
Abstract
To quantify the oncological risks of bladder-sparing therapy (BST) in patients with Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) compared to upfront radical cystectomy (RC).Pre-specified data elements were collected from retrospective cohorts of patients with BCG-unresponsive NMIBC from 10 international sites. After Institutional Review Board approval, patients were included if they had BCG-unresponsive NMIBC meeting United States Food and Drug Administration criteria. Oncological outcomes were collected following upfront RC or BST. BST regimens included re-resection or surveillance only, repeat BCG, intravesical chemotherapy, systemic immunotherapy, and clinical trials.Among 578 patients, 28% underwent upfront RC and 72% received BST. The median (interquartile range) follow-up was 50 (20-69) months. There were no statistically significant differences in metastasis-free survival, cancer-specific survival, or overall survival between treatment groups. In the BST group, high-grade recurrence rates were 37% and 52% at 12 and 24 months and progression to MIBC was observed in 7% and 13% at 12 and 24 months, respectively. RC was performed in 31.7% in the BST group and nodal disease was found in 13% compared with 4% in upfront RC (P = 0.030).In a selected cohort of patients, initial BST offers comparable survival outcomes to upfront RC in the intermediate term. Rates of recurrence and progression increase over time especially in patients treated with additional lines of BST.