膀胱癌第一期存活率—某區域醫院與全國2018至2022年之比較分析

盧致誠^1.2 范文宙¹ 鄭哲舟¹ 林嘉禾¹ 邱毅平¹ 王脩仁¹ 謝育哲¹

¹奇美醫療財團法人柳營奇美醫院 外科部 泌尿外科 ²國立中正大學 資訊管理學系

Analysis and comparison of bladder cancer stage I Survival Rates of a Regional teaching Hospital between 2018 and 2022

Chih-Cheng Lu^1,2, Wen-Chou Fan¹, Tse-Chou Cheng¹,Chia-Ho Lin¹, Yi-Ping Chiu¹, Hsiu-JenWang¹, Yu-Che Hsieh¹    

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Liouying, Tainan

²Department of Information Management, National Chung Cheng University, Chiayi

Purpose:

This analysis addresses the Health Promotion Administration's (HPA) concern that the hospital's 5-year survival rate for stage I bladder cancer is below the national average. It aims to investigate clinical characteristics and causes of death in stage I bladder cancer patients who died between 2018 and 2022.

Materials and Methods:

Data retrieved from Cancer Registry Database of the HPA cancer registry, the hospital's cancer registry database, and deceased patients' medical records. The study included 73 patients diagnosed with stage I bladder cancer at the hospital between 2018 and 2022, with 30 deaths (23 patients ≥ 65 years, 7 patients < 65 years). Medical records of deceased patients were reviewed for age, sex, ECOG performance status, comorbidities, pathological quality, other cancers, recurrence patterns, cause of death, and infection-related vs. non-infection-related death.

The hospital’s age-adjusted 5-year survival rate for stage I disease was compared with national, medical center, and non-medical center averages.

Results:

The hospital’s age-adjusted 5-year survival rate for stage I disease was compared with national, medical center, and non-medical center averages. The observed survival rate for stage I bladder cancer was 52.44% (age-adjusted: 52.36%), lower than the national average (65.12%), medical center average (64.92%), and non-medical center average (65.36%). Stage I cases comprised 49.66% of all bladder cancer cases, with a median survival of 61.4 months. Deceased Patients (n = 30) revealed 63.3% male, and 53.3% ≥ 80 years old, and 90% had at least one comorbidity. Muscularis propria was present in Transurethral resection of bladder tumor (TUR-BT) specimens in 76.7% of cases, suggesting potential under-staging in the remaining 23.3%. A history of other cancers was present in 26.7%. Recurrence occurred in 16.7%, with three patients progressing to advanced stages. Infection-related deaths, primarily from urinary tract infections, pneumonia, sepsis, and COVID-19. Non-infection-related deaths were mainly due to natural causes associated with advanced age or cerebrovascular events. The subgroup with survival ≤ 12 months (n = 8) was characterized by advanced age (≥ 80 years), multiple comorbidities, and septic shock.

Conclusion:

In the retrospective cohort study, lower survival rates were associated with advanced age (≥ 80 years), often due to comorbidities, infections, or organ failure and infection-related mortality, linked to compromised immunity and urinary complications. For improvement of pathological quality,

Include muscularis propria in TUR-BT specimens noting its presence on pathology requisitions to enhance staging. For strengthen multidisciplinary team (MDT), achieve ≥ 90% MDT discussion rate for stage I bladder cancer patients with other primary cancers to improve treatment planning. Longer follow-up to improve data completeness and quality for future analyses is needed.