实施血尿临床风险分层工具优化新冠肺炎时代高危膀胱癌患者管理

M. Wanis, M. Quraishi, T. Larner
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引用次数: 0

摘要

导读:受新冠肺炎疫情影响,选择性轮候名单变得更加紧张,患者等待治疗的时间明显更长。高危膀胱癌患者需要及时治疗,有强有力的证据表明,延迟治疗会增加疾病进展、转移和死亡的风险。研究表明,柔性膀胱镜下膀胱肿瘤的表现可以准确预测经尿道切除术后的组织病理学高危疾病。为了改进服务,作者对实践进行了回顾,并开发了血尿诊所的风险分层工具,旨在优先考虑高危疾病患者的途径。材料和方法:为血尿门诊新诊断的膀胱肿瘤患者开发了一种风险分层工具。在FC进行的肿瘤评估用于预测高风险疾病患者,从而使这些患者优先于等待名单上的低风险疾病患者。它还包括提醒人们要求对疑似高风险疾病患者进行分期调查。进行闭环审核以审查以下内容:血尿诊所肿瘤风险评估质量;从FC到经尿道膀胱肿瘤切除术(turt)的时间;FC肿瘤评估与TURBT术后组织病理学的一致性;可疑高危膀胱癌患者早期检查安排的有效性从FC到分期CT扫描的时间。结果:第二周期93%的患者进行了风险评估,而第一个周期为40%。在第一个周期中,83%的确诊为高风险非肌肉浸润性膀胱癌(NMIBC)和83%的确诊为肌肉浸润性膀胱癌(MIBC)的患者和100%的确诊为高风险NMIBC和MIBC的患者在第二个周期中出现了一致性。高危NMIBC患者从FC到TURBT的间隔时间从第一个周期的27天缩短至第二个周期的21天,高危NMIBC患者从27天缩短至13天。高危膀胱癌患者从FC到分期CT的时间为第一个周期6天,如果血尿门诊要求,第二个周期为3天。如果之后要求CT扫描,则第一个周期的间隔增加到39天,第二个周期的间隔增加到22天。结论:FC时的肿瘤风险评估与TURBT术后的最终病理有高度的一致性,这得到了多个系列的支持。在血尿门诊对新诊断的高危膀胱癌患者进行风险评估和分期调查可以最大限度地减少其治疗途径的延误,并改善患者的预后。
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The Implementation of a Risk Stratification Tool for the Haematuria Clinic to Optimise the Management of Patients with High-Risk Bladder Cancer in the COVID-19 Era
Introduction: Elective waiting lists have become more stretched because of the COVID-19 pandemic and patients have evidently been waiting longer for treatment. Patients with high-risk bladder cancer require timely treatment and there is strong evidence to suggest that delay in treatment contributes to a risk of disease progression, metastases and death. Studies have shown that bladder tumour appearances at flexible cystoscopy (FC) can accurately predict high-risk disease on histopathology following transurethral resec-tion. An opportunity for service improvement resulted in a review of the practice followed by the authors and the development of a risk stratification tool for the haematuria clinic which aimed to prioritise thepathway of those with high-risk disease.Materials and methods: A risk stratification tool was developed for patients with newly diagnosed bladder tumours at the haematuria clinic. A tumour assessment carried out at FC is used to predict patients with high-risk disease, thus allowing those patients to be prioritised over those with low-risk disease on the waiting list. It also includes a reminder to request staging investigations for those with suspected high-risk disease. A closed loop audit was carried to review the following: the quality of tumour risk assessment at the haematuria clinic; time from FC to transurethral resection of bladder tumour (TURBT); concordance between tumour assessment at FC and histopathology after TURBT; efficiency of arranging early staging investigations for those with suspected high-risk bladder cancer; time from FC to staging CT scan. Results: A risk assessment was carried out for 93% of patients in the second cycle compared with 40% in the first cycle. Concordance was noted in 83% of those with confirmed high-risk non-muscle invasive bladder cancer (NMIBC) and 83% of muscle invasive bladder cancer (MIBC) in the first cycle, and in 100% of patients with high-risk NMIBC and MIBC in the second cycle. The interval from FC to TURBT decreased from 27 days in the first cycle to 21 days in the second cycle in those with high-risk NMIBC, and from 27 to 13 days in those with MIBC. Time from FC to staging CT for patients with high-risk bladder cancer was 6 days in the first cycle and 3 days in the second cycle if the request was made from the haematuria clinic. If the CT scan was requested later, the interval increased to 39 days in the first cycle and 22 days in the second cycle.Conclusion: There is a high degree of concordance between tumour risk assessment at FC and final pathol-ogy following TURBT which is supported by several series. Performing risk assessment and requesting staging investigations at the haematuria clinic for patients with newly diagnosed high-risk bladder cancer can minimise delays in their treatment pathway and improve patient outcomes.
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