预测NMIBC的复发和进展:一个多事件和时间分析方法
Hugo Brouzes1, Said Ourfali2, Hakim Fassi-Fehri3
1Service d'Urologie et Chirurgie de la Transplantation, Hôpital Édouard-Herriot, Hospices Civils de Lyon, Lyon, France; Service d'Urologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard-Lyon 1, Lyon, France.
The French journal of urology
|June 23, 2025
概括
高风险的非肌肉侵入性膀癌 (NMIBC) 患者接受了Bacillus Calmette-Guérin (BCG) 治疗,面临着晚期复发和进展的持续风险. 量身定制的监测和膀保护治疗对这些患者至关重要.
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.
- 癌症研究 癌症研究
背景情况:
- 非肌肉侵入性膀癌 (NMIBC) 占膀癌病例的70-80%.
- 细菌卡尔梅特-盖林 (BCG) 治疗是标准的,但30%的患者没有反应,复发和进展率高.
- 现有的研究往往忽视了NMIBC的反复性.
研究的目的:
- 确定影响BCG治疗的NMIBC患者复发和进展的关键因素.
- 用先进的统计模型分析疾病复发和进展的复杂动态.
- 区分中等风险 (IR) 和高风险 (HR) NMIBC类别之间的复发模式.
主要方法:
- 对385名接受BCG治疗的NMIBC患者 (2012-2020年) 的回顾性分析.
- 分为EAU中等风险 (IR) 和高风险 (HR) 的分层.
- 应用多事件分析 (Cox比例危险,普伦蒂斯-威廉姆斯-彼得森总时间) 和多项物流回归用于时间复发动态.
主要成果:
- 多焦点性和之前的膀癌史预测了复发 (HR=2.07,P=0.001;HR=1.72,P=0.008).
- 高风险 (HR) 患者的肌肉侵入性膀癌 (MIBC) 的进展显著更高 (13.1%与4.5%,P=0.017).
- HR患者的晚期复发的几率增加 (pT2或更高;OR=2.71,P=0.001);晚期高度复发的风险与早期耐药瘤的风险相似.
结论:
- NMIBC复发动态是异质的,IR患者主要经历低度复发.
- 人力资源患者面临着高度和晚期疾病进展的持续风险.
- 这些发现支持HR NMIBC患者的个性化监测和膀保护治疗策略.
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