Survival Outcomes After Immediate Radical Cystectomy Versus Conservative Management with Bacillus Calmette-Guérin Among T1 High-grade Micropapillary Bladder Cancer Patients: Results from a Multicentre Collaboration.
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Lonati Chiara, Baumeister Philipp, Afferi Luca, Mari Andrea, Minervini Andrea, Krajewski Wojciech, Azizi Sosan, Hendricksen Kees, Martini Alberto, Necchi Andrea, Montorsi Francesco, Briganti Alberto, Colombo Renzo, Tafuri Alessandro, Antonelli Alessandro, Cerruto Maria Angela, Rouprêt Morgan, Masson-Lecomte Alexandra, Laukhtina Ekaterina, D'Andrea David, Shariat Shahrokh F, Soria Francesco, Marra Giancarlo, Gontero Paolo, Contieri Roberto, Hurle Rodolfo, Valiquette Anne Sophie, Mir M Carmen, Zamboni Stefania, Simeone Claudio, Klatte Tobias, Teoh Jeremy Yuen-Chun, Yoshida Soichiro, Fujii Yasuhisa, Carando Roberto, Schulz Gerald B, Mordasini Livio, Mattei Agostino, Moschini Marco, European Association of Urology Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group
Аннотация
OBJECTIVE: To assess cancer-specific mortality (CSM) and overall mortality (OM) between immediate radical cystectomy (RC) and conservative management among T1 high-grade (HG) MPBC.
DESIGN, SETTING, AND PARTICIPANTS: We retrospectively analysed a multicentre dataset including 119 T1 HG MPBC patients treated between 2005 and 2019 at 15 tertiary referral centres. The median follow-up time was 35 mo (interquartile range: 19-64).
INTERVENTION: Patients underwent immediate RC versus conservative management with bacillus Calmette-Guérin.
OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS: Cumulative incidence functions and Kaplan-Meier methods were applied to estimate survival outcomes. Multivariable Cox analyses were performed to assess independent predictors of disease recurrence and disease progression after conservative management; covariates consisted of pure MPBC, concomitant lymphovascular invasion (LVI), and carcinoma in situ at initial diagnosis.
RESULTS AND LIMITATIONS: Immediate RC and conservative management were performed in 27% and 73% of patients, respectively. CSM and OM did not differ significantly among patient treated with immediate RC versus conservative management (Pepe-Mori test p = 0.5 and log-rank test p = 0.9, respectively). Overall, 66.7% and 34.5% of patients experienced disease recurrence and disease progression after conservative management, respectively. At multivariable Cox analyses, concomitant LVI was an independent predictor of disease recurrence (p = 0.01) and progression (p = 0.03), while pure MPBC was independently associated with disease progression (p = 0.03). The absence of a centralised re-review and the retrospective design represent the main limitations of our study.
CONCLUSIONS: Conservative management could achieve satisfactory results among T1 HG MPBC patients with neither pure MPBC nor LVI at initial diagnosis.
PATIENT SUMMARY: Bacillus Calmette-Guérin seems to be an effective therapy for T1 micropapillary bladder cancer patients with neither pure micropapillary disease nor lymphovascular invasion at initial diagnosis.