高危非肌肉侵入性膀胱癌的现实结果：筛查Bravo试验的患者
Real-world outcomes for high-risk non-muscle-invasive bladder cancer: screened patients for the BRAVO trial
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:
Samantha Conroy, Ibrahim Jubber, Aidan P Noon, Derek J Rosario, Jon Griffin, Susan Morgan, Rachel Hubbard, Steve Kennish, Stephen Mitchell, Suresh Venugopal, Kate Linton, Ramanan Rajasundaram, Syed A Hussain, James W F Catto
摘要
报道现实世界中的高风险非肌肉侵入性膀胱癌（HRNMIBC），包括芽孢杆菌Calmette-guérin（BCG）（BCG）和自由基膀胱切除术（RC），因为它们的随机比较不可能进行随机的随机性参与者。 [ISRCTN] 12509361）。前瞻性注册的患者和用于结果的病例审查。主要结果是总体生存。次要结果包括复发，进展，转移和膀胱癌特异性生存。总共筛查了193例患者，包括106例接受BCG，43（22.3％）初级RC，37（22.3％），37（19.2％）（19.2％）“其他”治疗和7％（3.6％）的高疗中心均为5.5％的患者均为米西尔氏菌（28％）。 （四分位数[IQR]）为29.0（19.5-42.0）月。在多变量分析中，总体死亡率在老年患者中更为普遍（危险比[HR] 2.63，95％置信区间[CI] 1.35-5.13; COX P = 0.004年龄> 70岁），从地区医院招募的人（HR 0.53，95％CI 0.3-0.95; p = 0.03 as as at inc and as inc aft> 0.03; 95％CI 1.17-3.99;总共有17例（8.8％）患者死于膀胱癌（BC），中位数为22.5（19-36.25）月。在多变量分析中，在老年患者中，BC特异性死亡率更为普遍（HR 4.87，95％CI 1.1-21.6; P = 0.037）和TIS/T1疾病的患者（HR 2.26，95％CI 1.23-4.16; P = 0.008），但与初始治疗相关。那些选择RC作为初始治疗的人的死亡风险比其他人较低，尽管这可能反映了健身和选择。
Abstract
To report real-world outcomes for high-risk non-muscle-invasive bladder cancer (HRNMIBC), including bacillus Calmette-Guérin (BCG) and radical cystectomy (RC), as randomised comparisons of these have not been possible.We detail consecutive participants screened for the BRAVO randomised controlled trial comparing RC with BCG (International Standard Randomised Controlled Trial Number [ISRCTN]12509361). Patients were prospectively registered and case-note review used for outcomes. The primary outcome was overall survival. Secondary outcomes included recurrence, progression, metastasis, and bladder cancer-specific survival.A total of 193 patients were screened, including 106 (54.9%) who received BCG, 43 (22.3%) primary RC, 37 (19.2%) 'other' treatment and seven (3.6%) hyperthermic intravesical mitomycin C. All-cause death occurred in 55 (28.5%) patients at median (interquartile range [IQR]) of 29.0 (19.5-42.0) months. In multivariable analysis, overall mortality was more common in older patients (hazard ratio [HR] 2.63, 95% confidence interval [CI] 1.35-5.13; Cox P = 0.004 for age >70 years), those recruited from district hospitals (HR 0.53, 95% CI 0.3-0.95; P = 0.032) and those who did not undergo RC as their first treatment (HR 2.16, 95% CI 1.17-3.99; P = 0.014). In all, 17 (8.8%) patients died from bladder cancer (BC) at median (IQR) of 22.5 (19-36.25) months. In multivariable analysis, BC-specific mortality was more common in older patients (HR 4.87, 95% CI 1.1-21.6; P = 0.037) and those with Tis/T1 disease (HR 2.26, 95% CI 1.23-4.16; P = 0.008) but did not vary with initial treatment.Patients with HRNMIBC are at high-risk of mortality. Those choosing RC as their initial treatment have lower risks of mortality than others, although this may reflect fitness and selection.