非肌层侵犯谱系中原发性乳头状Ta级3膀胱癌的预后。
Prognosis of Primary Papillary Ta Grade 3 Bladder Cancer in the Non-muscle-invasive Spectrum.
发表日期：2023 Jan 18
作者：
Irene J Beijert, Anouk E Hentschel, Johannes Bründl, Eva M Compérat, Karin Plass, Oscar Rodríguez, Jose D Subiela Henríquez, Virginia Hernández, Enrique de la Peña, Isabel Alemany, Diana Turturica, Francesca Pisano, Francesco Soria, Otakar Čapoun, Lenka Bauerová, Michael Pešl, H Maxim Bruins, Willemien Runneboom, Sonja Herdegen, Johannes Breyer, Antonin Brisuda, Ana Calatrava, José Rubio-Briones, Maximilian Seles, Sebastian Mannweiler, Judith Bosschieter, Venkata R M Kusuma, David Ashabere, Nicolai Huebner, Juliette Cotte, Laura S Mertens, Francesco Claps, Alexandra Masson-Lecomte, Fredrik Liedberg, Daniel Cohen, Luca Lunelli, Olivier Cussenot, Soha El Sheikh, Dimitrios Volanis, Jean-François Côté, Morgan Rouprêt, Andrea Haitel, Shahrokh F Shariat, A Hugh Mostafid, Jakko A Nieuwenhuijzen, Richard Zigeuner, Jose L Dominguez-Escrig, Jaromir Hacek, Alexandre R Zlotta, Maximilian Burger, Matthias Evert, Christina A Hulsbergen-van de Kaa, Antoine G van der Heijden, Lambertus A L M Kiemeney, Viktor Soukup, Luca Molinaro, Paolo Gontero, Carlos Llorente, Ferran Algaba, Joan Palou, James N'Dow, Maria J Ribal, Theo H van der Kwast, Marko Babjuk, Richard J Sylvester, Bas W G van Rhijn
来源：
EUROPEAN UROLOGY ONCOLOGY
摘要：
Ta级3 (G3) 非肌层侵袭性膀胱癌 (NMIBC) 是一种罕见的诊断，其特点不明确，因为存在具有侵略性的G3成分和Ta成分的低恶性潜能。欧洲泌尿学协会 (EAU) 的NMIBC指南最近将Ta G3的风险分层从高风险改为中、高或非常高的风险。然而，关于Ta G3癌的预后研究是有限且不确定的。为评估将Ta G3分类与Ta G2和T1 G3癌的预后价值。分析了来自17家医院的5170例原发Ta-T1膀胱肿瘤的单个患者数据。肿瘤经尿道切除术于1990年至2018年之间进行。使用累积发生率函数、对数秩检验以及根据机构分层的交互作用项进行多变量Cox回归模型分析了复发时间和进展时间。Ta G3占Ta-T1癌的7.5% (387/5170)，其中42%被归类为中等风险。 Ta G3和Ta G2的复发时间没有差异 (p = 0.9)，T1 G3的差异也没有显著 (p = 0.4)。5年内进展出现在Ta G2的3.6% (95%可信区间[CI] 2.7-4.8%)，Ta G3的13% (95% CI 9.3-17%)和T1 G3的20% (95% CI 17-23%)。Ta G3的进展时间比Ta G2短 (p <0.001)，比T1 G3长 (p = 0.002)。患有侵袭性CIS的Ta G3 NMIBC患者预后更差，与患有CIS的T1 G3 NMIBC患者的时间到进展相似 (p = 0.5)。复发和进展的多元分析显示相似的结果。从进展的角度来看，Ta G3肿瘤的预后似乎介于Ta G2和T1 G3之间。然而，患有侵袭性CIS的Ta G3 NMIBC患者的预后比以前认为的要差，与患有CIS的T1 G3相当。我们的结果支持欧洲泌尿学协会NMIBC指南的最新变化，以更精细的风险分层分类Ta G3肿瘤，因为许多这些患者的预后比以前认为的要好。我们利用来自欧洲和加拿大的17个中心的数据评估了Ta级3 (G3) 非肌层侵袭性膀胱癌 (NMIBC) 患者的预后。Ta G3癌的癌症进展时间与Ta G2和T1 G3肿瘤均有所不同。我们的结果支持欧洲泌尿学协会指南最近对Ta G3 NMIBC的更精细化风险分层的改变，因为许多患有此肿瘤的患者具有比以前认为的更好的预后。Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.
Ta grade 3 (G3) non-muscle-invasive bladder cancer (NMIBC) is a relatively rare diagnosis with an ambiguous character owing to the presence of an aggressive G3 component together with the lower malignant potential of the Ta component. The European Association of Urology (EAU) NMIBC guidelines recently changed the risk stratification for Ta G3 from high risk to intermediate, high, or very high risk. However, prognostic studies on Ta G3 carcinomas are limited and inconclusive.To evaluate the prognostic value of categorizing Ta G3 compared to Ta G2 and T1 G3 carcinomas.Individual patient data for 5170 primary Ta-T1 bladder tumors from 17 hospitals were analyzed. Transurethral resection of the tumor was performed between 1990 and 2018.Time to recurrence and time to progression were analyzed using cumulative incidence functions, log-rank tests, and multivariable Cox-regression models with interaction terms stratified by institution.Ta G3 represented 7.5% (387/5170) of Ta-T1 carcinomas of which 42% were classified as intermediate risk. Time to recurrence did not differ between Ta G3 and Ta G2 (p = 0.9) or T1 G3 (p = 0.4). Progression at 5 yr occurred for 3.6% (95% confidence interval [CI] 2.7-4.8%) of Ta G2, 13% (95% CI 9.3-17%) of Ta G3, and 20% (95% CI 17-23%) of T1 G3 carcinomas. Time to progression for Ta G3 was shorter than for Ta G2 (p < 0.001) and longer than for T1 G3 (p = 0.002). Patients with Ta G3 NMIBC with concomitant carcinoma in situ (CIS) had worse prognosis and a similar time to progression as for patients with T1 G3 NMIBC with CIS (p = 0.5). Multivariable analyses for recurrence and progression showed similar results.The prognosis of Ta G3 tumors in terms of progression appears to be in between that of Ta G2 and T1 G3. However, patients with Ta G3 NMIBC with concomitant CIS have worse prognosis that is comparable to that of T1 G3 with CIS. Our results support the recent EAU NMIBC guideline changes for more refined risk stratification of Ta G3 tumors because many of these patients have better prognosis than previously thought.We used data from 17 centers in Europe and Canada to assess the prognosis for patients with stage Ta grade 3 (G3) non-muscle-invasive bladder cancer (NMIBC). Time to cancer progression for Ta G3 cancer differed from both Ta G2 and T1 G3 tumors. Our results support the recent change in the European Association of Urology guidelines for more refined risk stratification of Ta G3 NMIBC because many patients with this tumor have better prognosis than previously thought.Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.