原发性T1患者高级非肌肉浸润性膀胱癌的进展风险 - 现代队列
Risk of progression in patients with primary T1 high grade non-muscle invasive bladder cancer - a contemporary cohort
影响因子:9.30000
分区:医学1区 Top / 泌尿学与肾脏学1区 肿瘤学2区
发表日期:2025 Apr
作者:
Olga M Pijpers, Lisa M C van Hoogstraten, Sebastiaan Remmers, Irene J Beijert, Jorg R Oddens, J Alfred Witjes, Lambertus A Kiemeney, Katja K H Aben, Joost L Boormans
摘要
高危非肌肉侵入性膀胱癌（NMIBC）的患者接受了Calmette-Guérin（BCG）灌注，以降低进展的风险。对于具有非常高风险的NMIBC的患者，可以考虑立即进行自由基膀胱切除术，因为尽管接受BCG治疗的患者预后经历了疾病进展的患者。但是，指南征求进展风险的分层是基于未暴露于BCG的患者的数据。我们评估了当代高级/3级（Hg/g3）T1 NMIBC（n = 1268）的当代人群中进展的风险，他们至少接受了一次BCG滴注并接受了至少一项膀胱镜评估。主要终点是所有患者的进展风险和接受足够BCG的亚组的1年风险，定义为至少五次诱导灌输，至少有两次滴注为6 mo范围内的第二个BCG课程。进展定义为逼尿肌侵袭或淋巴结或远处转移。对于开始BCG治疗的原发性HG/G3 T1 NMIBC患者的1年风险为6.5％（95％置信区间[CI] 5.2-8.0），第二次BCG课程后，接受了BCG的患者后，接受BCG治疗的患者开始进行BCG治疗，为4.6％（95％CI 3.3-6.4）1年（95％CI 3.3-6.4）。总之，接受BCG的HG/G3 T1 NMIBC患者的当代风险似乎很低，尤其是对于接受足够BCG治疗的患者而言。患者摘要：我们的研究表明，对于接受BCG（Bacillus calmette-guérin）的高级膀胱肿瘤患者，疾病进展的风险在第一次BCG灌输后1年为6.5％。对于继续进行BCG维持治疗的患者，在第一次BCG维护滴注后，进展的风险为4.6％。
Abstract
Patients with high-risk non-muscle-invasive bladder cancer (NMIBC) receive bacillus Calmette-Guérin (BCG) instillations to reduce the risk of progression. For patients with very high-risk NMIBC, immediate radical cystectomy may be considered, as patients who experience disease progression despite BCG treatment have a worse prognosis. However, guideline-recommended stratification for the risk of progression is based on data from patients who were not exposed to BCG. We evaluated the risk of progression in a contemporary cohort of patients with primary high-grade/grade 3 (HG/G3) T1 NMIBC (n = 1268) who received at least one BCG instillation and underwent at least one cystoscopic evaluation. The primary endpoint was the 1-yr risk of progression for all patients and for the subgroup that received adequate BCG, defined as at least five induction instillations and at least two instillations provided as a second BCG course within 6 mo. Progression was defined as detrusor muscle invasion or lymph node or distant metastasis. The 1-yr risk of progression was 6.5% (95% confidence interval [CI] 5.2-8.0) for patients with primary HG/G3 T1 NMIBC who started BCG treatment, and 4.6% (95% CI 3.3-6.4) 1 yr after the first instillation of the second BCG course for patients who received adequate BCG (n = 746). In conclusion, the contemporary risk of progression for patients with HG/G3 T1 NMIBC who receive BCG appears to be low, especially for patients who receive adequate BCG treatment. PATIENT SUMMARY: Our study shows that for patients with a high-grade bladder tumor who received in-bladder BCG (bacillus Calmette-Guérin), the risk of disease progression was 6.5% at 1 yr after their first BCG instillation. For patients who continued with BCG maintenance treatments, the risk of progression was 4.6% after the first BCG maintenance instillation.