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DOI: 10.1055/s-0035-1549905
Anamnese, pathologische Originalbefunde, Therapie bezogene Parameter und Krankheitsverlauf: retrospektive Analyse von klinisch basierten Faktoren für die Prognose des tumorspezifischen Überlebens von 378 Patienten mit pT1-Harnblasenkarzinom
Anamnesis, Pathological Assessment, Therapeutic Features and Course of Disease: Retrospective Study on Clinical-Based Factors for Prediction of Cancer-Specific Survival of 378 Patients with Stage pT1 Urothelial Bladder CarcinomaPublikationsverlauf
Publikationsdatum:
12. Juni 2015 (online)
![](https://www.thieme-connect.de/media/uro/201503/lookinside/thumbnails/995_10-1055-s-0035-1549905-1.jpg)
Zusammenfassung
Hintergrund: Das Urothelkarzinom der Harnblase im Stadium pT1 ist eine Erkrankung mit heterogenem klinischem Verlauf. Die gängigen Prognosekriterien sind nicht für jeden Patienten geeignet. Die richtige Therapiestrategie für den einzelnen Patienten zu wählen, bleibt daher eine Herausforderung. Zielsetzung der vorliegenden Studie war es, klinische Einflussfaktoren auf das tumorspezifische Überleben (CSS) bei Patienten mit pT1 Harnblasenkarzinom zu identifizieren.
Material und Methoden: Es erfolgte die retrospektive Analyse klinischer Parameter aller Patienten aus einem Einzelzentrum (Zeitraum 1989–2012) mit der Diagnose eines pT1 Harnblasenkarzinoms. Die Behandlung beinhaltete stets transurethrale Resektion und Nachresektion. Eingeschlossen wurden nur Patienten mit initial Organ erhaltendem Therapieregime. Es wurden anamnestische Daten, histopathologischer Originalbefund, therapiebezogene Parameter sowie der klinische Verlauf in der Auswertung untersucht. Als Endpunkt wurde das CSS festgelegt. Die Auswertung mittels Kaplan-Meier Analyse, uni- und multivariater Analyse erfolgte mittels SPSS (Version 22, IBM).
Ergebnisse: 378 Patienten (78% männlich, medianes Alter 72 Jahre) wurden eingeschlossen, das mittlere Follow-up betrug 35 Monate. In der univariaten Analyse sowie in der Kaplan-Meier Analyse zeigten sich pT1G3 (66 vs. 91%, p<0,001), fehlende Instillationstherapie (66 vs. 83%, p<0,001), Vorliegen eines Zweittumors (41 vs. 77%, p=0,004), Diagnosezeitraum nach 2000 (75 vs. 76%, p=0,018), Rezidiv (58 vs. 85%, p<0,001) und Progress im Verlauf (42 vs. 85%, p<0,001) mit einem signifikant schlechteren CSS verbunden. In der multivariaten Analyse erwiesen sich Vorliegen eines Zweittumors (HR 2,267; CI 95% 1,143–4,497, p=0,019), pT1G3 bei Diagnosestellung (HR 4,567; CI 95% 2,040–10,22, p<0,001), Progress (HR 3,742; CI 95% 1,544–9,069, p=0,003) als unabhängige negative Prädiktoren für das CSS. Eine Instillationstherapie war ein prognostischer Faktor für ein besseres CSS (HR 0,368; CI 95% 0,212–0,638, p<0,001).
Schlussfolgerung: In der vorliegenden Untersuchung konnten Vorliegen von Zweittumoren, pT1G3-Befunde und Progress als negative Prädiktoren für das CSS identifiziert werden. Eine Instillationstherapie war mit einem besseren CSS verbunden.
Abstract
Background: Urothelial carcinoma of the bladder (UBC) at stage pT1 is a heterogenous disease. Established criteria for prognosis prediction are not suitable for every patient. Choosing the right therapeutic strategy for the individual patient thus remains a challenge. The aim of the present study was to identify clinical parameters regarding cancer-specific survival (CSS) in patients with pT1 UBC.
Materials and Methods: A retrospective analysis of clinical parameters of all patients with a pT1 UBC between 1989 and 2012 from a single centre was performed. Treatment consisted of transurethral resection, second resection followed by initially bladder sparing treatment. Anamnestic data, histopathological reports and clinical course were assessed with CSS being defined as primary endpoint. Kaplan-Meier analysis, uni- and multivariate analysis were performed using SPSS (Version 22, IBM).
Results: 378 patients (78% male, median age 72 years) were included, median follow-up was 35 months. Pathological stage pT1G3 (66 vs. 91%, p<0.001), lack of instillation therapy (66 vs. 83%, p<0.001), presence of a second malignoma (41 vs. 77%, p=0,004), diagnosis after 2000 (75 vs. 76%, p=0,018) and tumour progress (42 vs. 85%, p<0.001) were associated with a worse CSS in univariate and Kaplan-Meier analysis. Multivariate analysis revealed the presence of a second malignoma (HR 2.267; CI 95% 1.143–4.497, p=0.019), pathological stage pT1G3 at initial diagnosis (HR 4.567; CI 95% 2.040–10.22, p<0.001) and tumour progress (HR 3.742; CI 95% 1.544–9.069, p=0.003) as independent negative predictors of CSS. Instillation therapy was a prognostic factor for improved CSS (HR 0.368; CI 95% 0.212–0.638, p<0.001).
Conclusion: The present study identified the presence of a second malignoma, pathological stage pT1G3 and tumour progress as negative predictive factors for CSS. Maintenance instillation therapy after reresection was associated with an improved CSS.
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Literatur
- 1 Burger M, Catto JW, Dalbagni G et al. Epidemiology and risk factors of urothelial bladder cancer. Eur Urol 2013; 63: 234-241
- 2 Van Rhijn BWG, Burger M, Lotan Y et al. Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. Eur Urol 2009; 56: 430-442
- 3 Van Rhijn BWG, Liu L, Vis AN et al. Prognostic value of molecular markers, sub-stage and European Organisation for the Research and Treatment of Cancer risk scores in primary pT1 bladder cancer. BJU Int 2012; 110: 1169-1176
- 4 Cho KS, Seo HK, Joung JY et al. Lymphovascular invasion in transurethral resection specimens as predictor of progression and metastasis in patients with newly diagnosed pT1 bladder urothelial cancer. J Urol 2009; 182: 2625-2631
- 5 Chen Z, Ding W, Xu K et al. The 1973 WHO classification is more suitable than the 2004 WHO classification for predicting prognosis in non-muscle-invasive bladder cancer. Plos One 2012; 7: e47199 DOI: 10.1371/journal.pone.0047199. Epub 2012 Oct 17
- 6 Van Rhijn BWG, Zuiverloon TCM, Vis AN et al. Molecular grade (FGFR3/MIB-1) and EORTC risk scores are predictive in primary non-muscle-invasive bladder cancer. Eur Urol 2010; 58: 433-441
- 7 Burger M, van der Aa MN, van Oers JM et al. Prediction of progression of non-muscle-invasive bladder cancer by WHO 1973 and 2004 grading and by FGFR3 mutation status: a prospective study. Eur Urol 2008; 54: 835-843
- 8 Sylvester RJ, van der Meijden AP, Oosterlinck W et al. Predicting recurrence and progression in individual patients with Ta, T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 2006; 49: 466-475
- 9 Xylinas E, Kent M, Kluth L et al. Accuracy of the EORTC risk tables and the CUETO scorin modell to predict outcomes of non-muscle-invasive urothelial carcinoma of the bladder. BJC 2013; 109: 1460-1466
- 10 Fernandez-Gomez J, Madero R, Solsona E et al. The EORTC tables overestimate the risk of recurrence and progression of patients with non-muscle-invasive bladder cancer treated with Bacillus Calmette-Guerin: external validation of the EORTC risk tables. Eur Urol 2011; 60: 423-430
- 11 Burger M, Grossman HB, Droller M et al. Photodynamic diagnosis of non-muscle-invasive bladder cancer with hexosaminolevulinate cystoscopy: a meta-analysis of detection and recurrence based on raw data. Eur Urol 2013; 64: 846-854
- 12 Al-El-Dein B, Sooriakumaran P, Trinh QD et al. Construction of predictive models for recurrence and progression in >1000 patients with non-muscle-invasive bladder cancer (NMIBC) from a single-center. BJU Int 2013; 111: 331-341
- 13 Oddens JR, Sylvester RJ, Brausi MA et al. The effect of age on the effect of Bacillus Calmette-Guerin relative to maintenance with epirubicin in patients with stage Ta T1 urothelial bladder cancer results from EORTC Genito-Urinary Group Study 30911. Eur Urol 2014; 66: 694-701
- 14 Palou J, Sylvester RJ, Faba OR et al. Female gender and carcinoma in situ of the prostatic urethra are prognostic factors for recurrence, progression, and disease-specific mortality in T1G3 bladder cancer patients treated with Bacillus Calmette-Guerin. Eur Urol 2012; 62: 118-125
- 15 Rink M, Furberg H, Zabot EC et al. Impact of smoking and smoking cessation on oncologic outcomes in primary non-muscle-invasive bladder cancer. Eur Urol 2013; 63: 724-732
- 16 Hwang EC, Kim YJ, Hwang IS et al. Impact of diabetes mellitus on recurrence and progression in patients with non-muscle-invasive bladder carcinoma: a retrospective cohort study. Int J Urol 2011; 18: 769-776
- 17 Kluth LA, Xylinas E, Crivelli JJ et al. Obesity is associated with worse outcomes in patients with T1 high grade urothelial carcinoma of the bladder. J Urol 2013; 190: 480-486
- 18 Bosetti C et al. Trends in mortality from urologic cancers in Europe, 1970-2008. Eur Urol 2011; 60: 1-15
- 19 Otto W, May M, Fritsche HM et al. Analysis of sex differences in cancer-specific survival and perioperative mortality following radical cystectomy: results of a large German multicenter study of nearly 2500 patients with urothelial carcinoma of the bladder. Gend Med 2012; 9: 481-489
- 20 Kohjimoto Y, Kusumoto H, Nishizawa S et al. External validation of European Organization for Research and Treatment of Cancer and Spanish Urological Club for Oncological Treatment scoring models to predict recurrence and progression in Japanese patients with non-muscle invasive bladder cancer treated with bacillus Calmette-Guerin. Int J Urol 2014; 21: 1201-1207
- 21 Vedder MM, Márquez M, de Bekker-Grob EW et al. Risk prediction scores for recurrence and progression of non muscle invasive bladder cancer: an international validation in primary tumours. PLoS One 2014; 9: e96849
- 22 Otto W, Denzinger S, Fritsche HM et al. The WHO classification of 1973 is more suitable than the WHO classification of 2004 for predicting survival in pT1 urothelial bladder cancer. BJU Int 2011; 107: 404-408
- 23 Mikulowski P, Hellsten S. T1 G1 urinary bladder carcinoma: fact or fiction?. Scand J Urol Nephrol 2005; 39: 135-137
- 24 Lamm DL, Blumenstein BA, Crissman JD et al. Maintenance bacillus Calmette-Guerin immunotherapy for recurrent TA, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group Study. J Urol 2000; 163: 1124-1129
- 25 Herr HW, Laudone VP, Badalament RA et al. Bacillus Calmette-Guerin therapy alters the progression of superficial bladder cancer. J Clin Oncol 1988; 6: 1450-1455
- 26 Pawinski A, Sylvester R, Kurth KH et al. A combined analysis of European Organization for Research and Treatment of Cancer, and Medical Research Council randomized clinical trials for the prophylactic treatment of stage TaT1 bladder cancer. European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group and the Medical Research Council Working Party on Superficial Bladder Cancer. J Urol 1996; 156: 1934-1940 discussion 1940-1941
- 27 Huncharek M, McGarry R, Kupelnick B. Impact of intravesical chemotherapy on recurrence rate of recurrent superficial transitional cell carcinoma of the bladder: results of a meta-analysis. Anticancer Res 2001; 21: 765-769