膀胱非肌性浸润性微乳头状尿路上皮癌:初始膀胱切除术与膀胱内卡介苗-谷氨酰胺芽孢杆菌的不同应用

K. Gupta, D. Omil-Lima, Lin Chen, W. Muncey, Irma J. Lengu, K. Scarberry
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引用次数: 0

摘要

引言与目的微毛细血管尿路上皮癌(MPUC)是癌症中一种罕见的侵袭性组织学变异。治疗指南建议放弃卡介苗(BCG)治疗,而选择早期根治性膀胱切除术治疗非肌肉侵袭性(NMI)-MPUC,因为疾病进展率很高。我们旨在评估各中心对立即膀胱切除术和BCG患者的治疗效果。方法从国家癌症数据库(2004-2017)中确定MPUC患者。确定了病理性隆起的治疗趋势和发生率。进行双变量和多变量分析,以评估治疗方法的结果差异。结果在研究期间,1685名患者被诊断为MPUC,531名患者被确定为局限性Ta、T1或Tis疾病。24.1%的NMI-MPBC患者和16.3%的NMI非MPUC患者接受BCG作为初始治疗(p<0.001)。29.9%的MPUC和2.7%的非MPUC病例接受膀胱切除术作为NMI疾病的主要治疗(p>0.001),46.5%的MPUC患者从NMI-MPUC上升到T2-T4疾病,而非MPUC患者为37.3%(p=0.025)。33.1%的MPUC病人从病理性N1-3疾病上升到非MPUC病人为11.9%(p<0.001)。Cox回归分析,调整患者年龄、性别、种族、合并症和疾病分期,与社区癌症中心相比,学术癌症中心的护理与将膀胱切除术作为主要治疗的几率增加相关(OR=4.29,95%CI 2.73-7.76)。与社区癌症中心的患者相比,在学术癌症中心接受治疗的NMI-MPUC患者更有可能接受根治性手术作为主要治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Non-muscle invasive micropapillary urothelial carcinoma of the bladder: Variable use of initial cystectomy versus intravesical bacillus calmette-guérin
Introduction and Objective Micropapillary urothelial carcinoma (MPUC) is a rare and aggressive histologic variant of bladder cancer. Treatment guidelines recommend forgoing Bacillus Calmette-Guérin (BCG) therapy in favor of early radical cystectomy for non-muscle invasive (NMI)-MPUC due to high rates of disease progression. We aimed to evaluate its management in patients with immediate cystectomy and BCG across various centers. Methods Patients with MPUC were identified from the National Cancer Database (2004-2017). Treatment trends and rates of pathological upstaging were identified. Bivariate and multivariate analyses were performed to assess differences in outcomes by treatment approach. Results 1,685 patients were diagnosed with MPUC during the study period with 531 identified with localized Ta, T1, or Tis disease. BCG was administered as an initial therapy in 24.1% of NMI-MPBC patients and in 16.3% of NMI-non-MPUC patients (p<0.001). Cystectomy was performed as primary therapy for NMI disease in 29.9% of MPUC and in 2.7% of non-MPUC patients (p<0.001). Of the patients who underwent primary cystectomy, upstaging from NMI-MPUC to T2-T4 disease was seen in 46.5% of the MPUC patients compared to 37.3% in patients with non-MPUC (p=0.025). Upstaging to pathologic N1-3 disease was observed in 33.1% of MPUC patients compared to 11.9% non-MPUC patients (p<0.001). Cox regression analysis, adjusting for patient age, sex, race, comorbidities, and disease stage, care at academic cancer centers were associated with increased odds of having cystectomy as primary therapy compared to community cancer centers (OR = 4.29, 95% CI 2.73-6.76). Conclusion The current study lends evidence to current practice guidelines by reporting treatment patterns for patients with micropapillary bladder cancer across a broad spectrum of clinical practice. NMI-MPUC patients treated at academic cancer centers were more likely to receive radical surgery as primary treatment compared to patients at the community cancer centers.
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