膀癌治疗途径的图像导向重新设计:BladderPath RCT
Nicholas James1, Sarah Pirrie2, Wenyu Liu2
1Institute of Cancer Research, London, UK.
Health technology assessment (Winchester, England)
|September 9, 2024
概括
多参数MRI显著减少了肌肉侵入性膀癌的治疗延迟. 这种成像方法提供了准确的分期,可能避免不必要的程序,并改善患者的结果.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 在瘤学瘤学.
- 放射学 放射学是指放射学
背景情况:
- 经尿道切除膀瘤 (TURBT) 历来是膀癌分期的标准,但往往导致不准确和治疗延迟.
- 肌肉侵入性膀癌 (MIBC) 需要及时和准确的分期,以获得有效的激进治疗.
- 多参数磁共振成像 (mpMRI) 为快速准确的MIBC分期提供了一个非侵入性的替代方案.
研究的目的:
- 评估在 TURBT 之前整合mpMRI的可行性和有效性,以怀疑MIBC分期.
- 评估mpMRI是否可以提高诊断的准确性和速度以及随后的治疗启动.
主要方法:
- 这是一项开放式的多阶段随机对照研究,涉及15家英国医院的143名新诊断的膀癌患者.
- 患者被随机分配到两条路径:路径1 (标准TURBT) 和路径2 (怀疑MIBC的mpMRI,必要时再进行TURBT).
- 关键结果包括在可行性阶段遵守协议,以及在中间阶段纠正MIBC治疗的时间.
主要成果:
- 在mpMRI导向的途径 (途径2) 证明了高的协议遵守 (92%的MIBC).
- 在途径2 (53天) 中,与途径1 (98天) 相比,MIBC治疗纠正的中位时间显著减少,危险比为2.9 (p=0.040).
- 在途径2 (25天) 和途径1 (37天) 中,整体中位时间纠正治疗也较短.
结论:
- 该mpMRI导向途径显著减少了45天的MIBC治疗时间,而不会对非MIBC患者产生负面影响.
- 建议在TURBT之前将mpMRI纳入怀疑MIBC的标准护理,以改善决策和加快治疗.
- 这种方法可以降低成本和发病率,使一些患者能够避免TURBT,并促进更早的最终治疗.
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