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

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.

Schlüsselwörter

Harnblasenkarzinom - Stadium pT1 - transurethrale Resektion der Harnblase - WHO Grading 1973 - Instillationstherapie

Key words

urothelial bladder carcinoma - stage pT1 - transurethral resection - WHO 1973 grading - instillation therapy

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