Real-word outcomes for high-risk non-muscle-invasive bladder cancer: screened patients for the BRAVO trial.

IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY BJU International Pub Date : 2024-09-26 DOI:10.1111/bju.16516
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
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Abstract

OBJECTIVE 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. METHODS 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. RESULTS AND LIMITATIONS 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. CONCLUSIONS 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.
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高风险非肌层浸润性膀胱癌的实际疗效:BRAVO 试验筛选出的患者。
目的报告高危非肌层浸润性膀胱癌(HRNMIBC)的实际治疗效果,包括卡介苗(BCG)和根治性膀胱切除术(RC),因为无法对这些治疗方法进行随机比较。方法我们详细记录了BRAVO随机对照试验(国际标准随机对照试验编号 [ISRCTN]12509361 )筛选出的连续参与者,对RC和BCG进行了比较。对患者进行了前瞻性登记,并采用病例记录回顾法对结果进行分析。主要结果是总生存期。共有 193 名患者接受了筛查,其中 106 人(54.9%)接受了卡介苗治疗,43 人(22.3%)接受了原发性膀胱癌治疗,37 人(22.3%)接受了膀胱癌治疗。55例(28.5%)患者在中位(四分位间距 [IQR])29.0(19.5-42.0)个月时因各种原因死亡。在多变量分析中,老年患者(危险比 [HR] 2.63,95% 置信区间 [CI] 1.35-5.13;年龄大于 70 岁,Cox P = 0.004)、从地区医院招募的患者(HR 0.53,95% CI 0.3-0.95;P = 0.032)和首次治疗未接受 RC 的患者(HR 2.16,95% CI 1.17-3.99;P = 0.014)的总死亡率更高。共有 17 名(8.8%)患者在中位(IQR)22.5(19-36.25)个月时死于膀胱癌(BC)。在多变量分析中,BC特异性死亡率更常见于年龄较大的患者(HR 4.87,95% CI 1.1-21.6;P = 0.037)和患有Tis/T1疾病的患者(HR 2.26,95% CI 1.23-4.16;P = 0.008),但与初始治疗方法无关。选择 RC 作为初始治疗方法的患者的死亡风险低于其他患者,尽管这可能反映了患者的体质和选择。
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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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