Long-term outcomes of bladder-sparing therapy vs radical cystectomy in BCG-unresponsive non-muscle-invasive bladder cancer.

IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY
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
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引用次数: 0

Abstract

Objective: 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).

Patients and methods: 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.

Results: 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).

Conclusion: 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.

对卡介苗无反应的非肌层浸润性膀胱癌,保膀胱疗法与根治性膀胱切除术的长期疗效对比。
目的量化对卡介苗(BCG)无反应的非肌层浸润性膀胱癌(NMIBC)患者进行膀胱保留治疗(BST)与前期根治性膀胱切除术(RC)相比的肿瘤风险:从10个国际研究机构的卡介苗(BCG)无反应性非肌层浸润性膀胱癌(NMIBC)患者回顾性队列中收集了预先指定的数据元素。经机构审查委员会批准后,符合美国食品和药物管理局标准的卡介苗无反应NMIBC患者被纳入研究范围。收集了前期 RC 或 BST 后的肿瘤学结果。BST方案包括再次切除或仅监测、重复卡介苗、膀胱内化疗、全身免疫疗法和临床试验:在578名患者中,28%接受了前期RC,72%接受了BST。随访中位数(四分位数间距)为 50(20-69)个月。不同治疗组的无转移生存率、癌症特异性生存率和总生存率无明显统计学差异。在 BST 组中,12 个月和 24 个月的高级别复发率分别为 37% 和 52%,12 个月和 24 个月的 MIBC 进展率分别为 7% 和 13%。BST组中有31.7%的患者接受了RC治疗,13%的患者发现了结节病,而前期RC治疗中仅有4%的患者发现了结节病(P = 0.030):结论:在选定的患者群体中,初始 BST 的中期生存效果与前期 RC 相当。随着时间的推移,复发率和病情进展率会增加,特别是在接受了更多线 BST 治疗的患者中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BJU International
BJU International 医学-泌尿学与肾脏学
CiteScore
9.10
自引率
4.40%
发文量
262
审稿时长
1 months
期刊介绍: BJUI is one of the most highly respected medical journals in the world, with a truly international range of published papers and appeal. Every issue gives invaluable practical information in the form of original articles, reviews, comments, surgical education articles, and translational science articles in the field of urology. BJUI employs topical sections, and is in full colour, making it easier to browse or search for something specific.
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