Altay B, Girgin C, Kefi A, Cikili N
Department of Urology, Ege University, Medical Faculty Hospital, Izmir, Turkey.
Int Urol Nephrol. 2000;32(1):53-8. doi: 10.1023/a:1007199932271.
To compare retrospectively the recurrence rates of TUR alone versus different intravesical chemotherapy modalities in superficial bladder cancer cases, 187 patients with stage Ta and T1 bladder tumours were treated with transurethral resection followed by adjuvant intravesical chemotherapy with mitomycin, BCG or epirubicin or by transurethral resection alone. All patients in this study had historically proven transurethrally resectable primary, category Ta and T1 transitional cell carcinoma (TCC) of the bladder. Group I included transurethral resection alone, and the other groups included intravesical mitomycin-C (Group II), BCG (Group III) and epirubicin (Group IV) therapies after transurethral resection. 146 male and 41 female patients (78% male and 22% female patients) in this study were diagnosed as primary TCC bladder tumours. Only 52 of them were stage Ta and 135 of them were stage T1 bladder tumours. Examining the histological grade of the bladder tumours, 88 (47%) of the patients had grade I, 53 (28%) had grade IIa, 30 (16%) had grade IIb and remaining 16 (9%) had grade III bladder cancers. The recurrence rates were 25% for Group I, 23.8% for Group II, 26.2% for Group III and 22.7% for Group IV. These values were given with disregarding the grade and volume of the bladder tumours. For solitary, less than 3 cm low grade tumours (grade I, IIa) recurrence rates were 16% for Group I, 15.4% for Group II, 17.8% for Group III, 17.2% for Group IV (p > 0.05). As a result of this retrospective study, for patients with low grade, stage Ta and T1 tumours TUR alone may be the best treatment modality. Although intravesical chemotherapy is effective in decreasing short-term incidences of tumour recurrence, it has not decreased long-term incidences of tumour recurrence. The high cost and adverse side effects of intravesical chemotherapy should also be taken into consideration in superficial, single, low grade tumours of bladder.
为了回顾性比较单纯经尿道膀胱肿瘤切除术（TUR）与不同膀胱内化疗方式在浅表性膀胱癌病例中的复发率，187例Ta期和T1期膀胱肿瘤患者接受了经尿道切除术，随后分别接受丝裂霉素、卡介苗（BCG）或表柔比星膀胱内化疗，或仅接受经尿道切除术。本研究中的所有患者既往均经证实经尿道可切除原发性Ta期和T1期膀胱移行细胞癌（TCC）。第一组仅包括经尿道切除术，其他组包括经尿道切除术后膀胱内丝裂霉素-C治疗（第二组）、卡介苗治疗（第三组）和表柔比星治疗（第四组）。本研究中的146例男性和41例女性患者（78%为男性，22%为女性）被诊断为原发性膀胱TCC肿瘤。其中仅52例为Ta期，135例为T1期膀胱肿瘤。检查膀胱肿瘤的组织学分级，88例（47%）患者为I级，53例（28%）为IIa级，30例（16%）为IIb级，其余16例（9%）为III级膀胱癌。第一组的复发率为25%，第二组为23.8%，第三组为26.2%，第四组为22.7%。这些数值未考虑膀胱肿瘤的分级和体积。对于孤立的、小于3 cm的低级别肿瘤（I级、IIa级），第一组的复发率为16%，第二组为15.4%，第三组为17.8%，第四组为17.2%（p>0.05）。这项回顾性研究的结果表明，对于低级别Ta期和T1期肿瘤患者，单纯TUR可能是最佳治疗方式。尽管膀胱内化疗在降低肿瘤复发的短期发生率方面有效，但并未降低肿瘤复发的长期发生率。对于膀胱浅表、单发、低级别肿瘤，还应考虑膀胱内化疗的高成本和不良副作用。
