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The prognostic impact of hexaminolevulinate-based bladder tumor resection in patients with primary non-muscle invasive bladder cancer treated with radical cystectomy.

根治性膀胱切除术治疗原发性非肌层浸润性膀胱癌患者中基于六羟氨酰戊酸的膀胱肿瘤切除术的预后影响。

  • 影响因子:2.56
  • DOI:10.1007/s00345-019-02780-0
  • 作者列表:"Renninger M","Fahmy O","Schubert T","Schmid MA","Hassan F","Stenzl A","Gakis G
  • 发表时间:2020-02-01
Abstract

PURPOSE:To investigate whether hexaminolevulinate-based (HAL) bladder tumor resection (TURBT) impacts on outcomes of patients with primary non-muscle-invasive bladder cancer (NMIBC) who were eventually treated with radical cystectomy (RC). METHODS:A total of 131 consecutive patients exhibiting NMIBC at primary diagnosis were retrospectively investigated whether they had undergone any HAL-guided TURBT prior to RC. Uni- and multivariable analyses were used to evaluate the impact of HAL-TURBT on cancer-specific (CSS) and overall survival (OS). The median follow-up was 38 months (IQR 13-56). RESULTS:Of the 131 patients, 69 (52.7%) were managed with HAL- and 62 (47.3%) with white light (WL)-TURBT only prior to RC. HAL-TURBT was associated with a higher number of TURBTs prior to RC (p = 0.002) and administration of intravesical chemotherapy (p = 0.043). A trend towards a higher rate of tumor-associated immune cell infiltrates in RC specimens (p = 0.07) and a lower utilization rate of post-operative systemic chemotherapy (p = 0.10) was noted for patients who were treated with HAL-TURBT. The 5-year CSS/OS was 90.9%/74.5% for the HAL-group and 73.8%/55.8% for the WL-group (p = 0.042/0.038). In multivariable analysis, lymph node tumor involvement (p = 0.007), positive surgical margins (p = 0.001) and performance of WL-TURBT only (p = 0.040) were independent predictors for cancer-specific death. CONCLUSIONS:The present data suggest that the resection of NMIBC under HAL exerts a beneficial impact on outcomes of patients who will need to undergo RC during their course of disease. This finding may be due to improved risk stratification as the resection under HAL may allow more patients to be treated timely and adequately.

摘要

目的: 探讨基于六羟氨酰戊酸 (HAL) 的膀胱肿瘤切除术 (TURBT) 对原发性非肌层浸润性膀胱癌 (NMIBC) 患者预后的影响。最终接受根治性膀胱切除术 (RC) 的患者。 方法: 回顾性调查了 131 例初诊时出现NMIBC的连续患者,他们在RC之前是否接受了任何HAL引导下的TURBT。采用单变量和多变量分析评价HAL-TURBT对癌症特异性 (CSS) 和总生存期 (OS) 的影响。中位随访时间为 38 个月 (IQR 13-56)。 结果: 在 131 例患者中,69 例 (52.7%) 仅在RC之前使用HAL-和 62 例 (47.3%) 白光 (WL)-TURBT进行治疗。HAL-TURBT与RC (p = 0.002) 和膀胱内化疗 (p = 0.043) 前较高的TURBT数量相关。RC标本中肿瘤相关免疫细胞浸润率较高 (p = 0.07) 和术后全身化疗使用率较低 (p = 0.10) 的趋势HAL-TURBT治疗的患者。在 5 年的CSS/OS 90.9%/74.5% 的HAL组和 73.8%/5 5.8% WL (p  =   0.042/0.038).在多变量分析中,淋巴结肿瘤受累 (p = 0.007) 、手术切缘阳性 (p = 0.001) 和仅WL-TURBT表现 (p = 0.040) 是癌症特异性死亡的独立预测因子。 结论: 目前的数据表明,HAL下NMIBC的切除对病程中需要接受RC的患者的结局产生有益的影响。这一发现可能是由于风险分层的改善,因为HAL下的切除可能允许更多的患者得到及时和充分的治疗。

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影响因子:2.56
发表时间:2020-02-01
DOI:10.1007/s00345-019-02780-0
作者列表:["Renninger M","Fahmy O","Schubert T","Schmid MA","Hassan F","Stenzl A","Gakis G"]

METHODS:PURPOSE:To investigate whether hexaminolevulinate-based (HAL) bladder tumor resection (TURBT) impacts on outcomes of patients with primary non-muscle-invasive bladder cancer (NMIBC) who were eventually treated with radical cystectomy (RC). METHODS:A total of 131 consecutive patients exhibiting NMIBC at primary diagnosis were retrospectively investigated whether they had undergone any HAL-guided TURBT prior to RC. Uni- and multivariable analyses were used to evaluate the impact of HAL-TURBT on cancer-specific (CSS) and overall survival (OS). The median follow-up was 38 months (IQR 13-56). RESULTS:Of the 131 patients, 69 (52.7%) were managed with HAL- and 62 (47.3%) with white light (WL)-TURBT only prior to RC. HAL-TURBT was associated with a higher number of TURBTs prior to RC (p = 0.002) and administration of intravesical chemotherapy (p = 0.043). A trend towards a higher rate of tumor-associated immune cell infiltrates in RC specimens (p = 0.07) and a lower utilization rate of post-operative systemic chemotherapy (p = 0.10) was noted for patients who were treated with HAL-TURBT. The 5-year CSS/OS was 90.9%/74.5% for the HAL-group and 73.8%/55.8% for the WL-group (p = 0.042/0.038). In multivariable analysis, lymph node tumor involvement (p = 0.007), positive surgical margins (p = 0.001) and performance of WL-TURBT only (p = 0.040) were independent predictors for cancer-specific death. CONCLUSIONS:The present data suggest that the resection of NMIBC under HAL exerts a beneficial impact on outcomes of patients who will need to undergo RC during their course of disease. This finding may be due to improved risk stratification as the resection under HAL may allow more patients to be treated timely and adequately.

翻译标题与摘要 下载文献
影响因子:1.46
发表时间:2020-02-01
来源期刊:The Journal of urology
DOI:10.1097/JU.0000000000000313
作者列表:["Alder R","Zetner D","Rosenberg J"]

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泌尿外科手术方向

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