TaHG非肌层浸润性膀胱癌患者再次经尿道切除膀胱肿瘤的作用。

IF 2.8 2区 医学 Q2 UROLOGY & NEPHROLOGY World Journal of Urology Pub Date : 2024-11-06 DOI:10.1007/s00345-024-05342-1
Pietro Scilipoti, Marco Moschini, Mario de Angelis, Luca Afferi, Chiara Lonati, Mattia Longoni, Giovanni Tremolada, Paolo Zaurito, Alessandro Viti, Alfonso Santangelo, Renate Pichler, Andrea Necchi, Francesco Montorsi, Alberto Briganti, Andrea Mari, Wojciech Krajewski, Ekaterina Laukthina, Benjamin Pradere, Francesco Del Giudice, Laura Mertens, Andrea Gallioli, Francesco Soria, Paolo Gontero, Simone Albisinni, Shahrokh F Shariat, Roberto Carando
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引用次数: 0

摘要

目的:关于Ta高级别(HG)非肌浸润性膀胱癌(NMIBC)再次经尿道膀胱肿瘤切除术(reTURBT)的适应症尚缺乏证据。本研究旨在评估 TaHG 非肌层浸润性膀胱癌患者的肿瘤治疗效果,以确定实施再经尿道膀胱肿瘤切除术的益处:方法:我们对 2009 年至 2021 年间来自 12 个中心的 317 例 TaHG NMIBC 患者进行了多中心队列研究,这些患者接受了 TURBT 和随后的完全卡介苗诱导治疗。卡普兰-梅耶尔分析根据再TURBT估计了无复发生存期(RFS)和无进展生存期(PFS)。子分析评估了根据国际指南(多发、大小大于 3 厘米、复发癌、原位癌、淋巴管侵犯、组织学变异、初次 TURBT 时肌肉层不完整或缺失)显示有必要再次进行 TURBT 的多重风险因素患者的 PFS。多变量考克斯回归分析预测了复发和进展情况:在317名患者中,123人(39%)接受了TURBT,194人(61%)未接受TURBT。46%的病例发现了残留疾病,上行分期率为3.2%。中位随访时间为 30 个月。接受再TURBT治疗的患者的3年RFS较高(79%对58%,P 结论:再TURBT治疗显示了疗效:ReTURBT在减少TaHG NMIBC患者复发方面具有疗效,但其对病情进展的影响仍不确定。我们的研究强调了遵守现行国际指南的重要性,尤其是对于具有多种风险因素,表明有必要进行再TURBT的患者。
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The role of re-transurethral resection of bladder tumor in patients with TaHG non muscle invasive bladder cancer.

Purpose: There is lack of evidence regarding the indication for re-transurethral resection of bladder tumor (reTURBT) for Ta high grade (HG) non-muscle invasive bladder cancer (NMIBC). This study aims to evaluate the oncological outcomes of patients with TaHG NMIBC to determine the benefit from performing reTURBT.

Methods: We relied on a multicenter cohort of 317 TaHG NMIBC from 12 centers who underwent TURBT and a subsequent complete Bacillus Calmette-Guérin induction from 2009 to 2021. Kaplan Meier analyses estimated recurrence free survival (RFS) and progression free survival (PFS) according to reTURBT. Sub-analyses evaluated PFS in patients with multiple risk factors indicating necessity for reTURBT according to international guidelines (multifocality, size > 3 cm, recurrent cancer, carcinoma in situ, lymph vascular invasion, histological variant, incomplete and absence of muscle layer at index TURBT). Multivariable cox-regression analysis predicted recurrence and progression.

Results: Of the 317 patients, 123 (39%) underwent reTURBT, while 194 (61%) did not. Residual disease was detected in 46% of cases, with a 3.2% upstaging rate. Median follow-up was 30 months. The 3-year RFS was higher in patients who underwent reTURBT (79% vs. 58%, p < 0.001), but no significant difference was observed in PFS. ReTURBT reduced the risk of recurrence [multivariable hazard ratio: 0.45, 95% Confidence interval (CI) 0.29-0.71]. Among patients who did not undergo reTURBT, those with ≥ 2 risk factors had lower 3-year PFS (73% vs. 92%, p < 0.001) than those with 0-1 risk factor, whereas no difference in 3-year PFS was observed in patients who underwent reTURBT regardless of the number of risk factors (85% vs. 87%, p = 0.8).

Conclusion: ReTURBT demonstrated efficacy in reducing recurrence among patients with TaHG NMIBC, yet its impact on progression remained uncertain. Our study underscores the importance of adhering to current international guidelines, particularly for patients with multiple risk factors indicating necessity for reTURBT.

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来源期刊
World Journal of Urology
World Journal of Urology 医学-泌尿学与肾脏学
CiteScore
6.80
自引率
8.80%
发文量
317
审稿时长
4-8 weeks
期刊介绍: The WORLD JOURNAL OF UROLOGY conveys regularly the essential results of urological research and their practical and clinical relevance to a broad audience of urologists in research and clinical practice. In order to guarantee a balanced program, articles are published to reflect the developments in all fields of urology on an internationally advanced level. Each issue treats a main topic in review articles of invited international experts. Free papers are unrelated articles to the main topic.
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