Background and Objective: The role of urine cytology during follow-up for low-grade (LG) non-muscle-invasive bladder cancer (NMIBC) is not well established, although cytology has low sensitivity in detecting LG recurrences. Our study aims to evaluate the impact of urine cytology as a complementary method to cystoscopy during follow-up for LG NMIBC. Methods: Patients diagnosed with primary LG TaT1 bladder cancer (BC) between 2010 and 2020 were included. Patients were stratified according to the EAU NMIBC scoring model. Urine cytology was performed during follow-up cystoscopy. The outcomes of the study were BC recurrence and upgrading to high-grade (HG). Cytology utility was established by assessing whether its result led to management change. Results: We included 337 patients with LG TaT1 BC. EAU risk group distribution was low in 262 (77.7%), intermediate in 57 (16.9%), and high-risk in 18 (5.3%) cases. With a median follow-up of 5 years, 166 (49.3%) patients experienced recurrence. Cystoscopy was positive in 154 (92.8%) and suspicious in 12 (7.2%) cases. Urine cytology was positive in 33 (19.9%) cases but only changed management in 3 (0.89%), all with suspicious cystoscopy. Positive cytology at first recurrence was associated with higher risk of upgrading during follow-up (HR 2.781,p= 0.006) and lower upgrading-free survival (p= 0.001). Conclusions: The role of urine cytology to detect first recurrences during follow-up for primary LG TaT1 NMIBC might be limited to patients with non-conclusive lesions in the cystoscopy. A positive cytology at first recurrence is associated with a higher risk of upgrading to HG BC during follow-up.
背景与目的：尽管尿液细胞学检查在检测低级别非肌层浸润性膀胱癌复发时敏感性较低，但其在低级别非肌层浸润性膀胱癌随访中的作用尚未明确。本研究旨在评估在低级别非肌层浸润性膀胱癌随访过程中，尿液细胞学检查作为膀胱镜检查辅助手段的影响。方法：纳入2010年至2020年间确诊的原发性低级别TaT1膀胱癌患者，根据欧洲泌尿外科学会非肌层浸润性膀胱癌评分模型进行风险分层。在随访膀胱镜检查期间同步进行尿液细胞学检测。研究终点为膀胱癌复发及升级为高级别肿瘤。通过评估细胞学结果是否改变临床决策来判定其效用。结果：共纳入337例低级别TaT1膀胱癌患者，欧洲泌尿外科学会风险分组显示低危262例（77.7%）、中危57例（16.9%）、高危18例（5.3%）。中位随访5年期间，166例（49.3%）患者出现复发。膀胱镜检查阳性154例（92.8%），可疑12例（7.2%）。尿液细胞学阳性33例（19.9%），但仅改变3例（0.89%）患者的临床决策，且均为膀胱镜检查可疑病例。首次复发时细胞学阳性与随访期间升级风险升高相关（风险比2.781，p=0.006），且无升级生存期显著缩短（p=0.001）。结论：在原发性低级别TaT1非肌层浸润性膀胱癌随访中，尿液细胞学检测首次复发的作用可能仅限于膀胱镜检查结果不明确的患者。首次复发时细胞学阳性与随访期间升级为高级别膀胱癌的风险增高相关。
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