原发T1高危非肌层浸润性膀胱癌患者的进展风险——一项当代表队研究

Risk of progression in patients with primary T1 high grade non-muscle invasive bladder cancer - a contemporary cohort

EUROPEAN UROLOGY ONCOLOGY

影响因子:9.3

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

DOI: 10.1016/j.euo.2024.09.006

摘要

高危非肌层浸润性膀胱癌（NMIBC）患者接受卡介苗（BCG）灌注以降低进展风险。对于极高危NMIBC患者，可考虑立即进行根治性膀胱切除术，因为尽管接受BCG治疗，仍发生病情进展的患者预后较差。然而，指南推荐的进展风险分层主要基于未接受BCG的患者数据。我们评估了在一组现代患者队列中的风险情况，这些患者为原发性高分级/三级（HG/G3）T1 NMIBC（n=1268），接受至少一次BCG灌注，并进行了至少一次膀胱镜检查。主要终点为所有患者以及符合“充分BCG”定义（至少五次诱导灌注和两次作为第二次BCG疗程在6个月内的灌注）患者的1年进展风险。进展定义为逼近逼肌层侵犯或淋巴结或远处转移。对接受BCG治疗的高危T1 NMIBC患者，1年进展风险为6.5%（95% CI 5.2-8.0），而在充分BCG治疗（n=746）患者中，第一剂后1年进展风险为4.6%（95% CI 3.3-6.4）。结论是，接受BCG治疗的现代高危T1 NMIBC患者的进展风险较低，尤其是接受充分BCG治疗的患者。患者摘要：我们的研究显示，高级别膀胱肿瘤患者接受膀胱内BCG后，1年内疾病进展的风险为6.5%。继续接受BCG维持治疗的患者，第一剂后进展风险为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.