Soloway Mark S, Sofer Mario, Vaidya Anil
Department of Urology, University of Miami, Miami, Florida, USA.
J Urol. 2002 Apr;167(4):1573-83.
Transitional cell carcinoma involving the lamina propria (stage T1) is associated with a high recurrence and progression rate with implications for patient survival and quality of life. A better understanding of the natural history of and treatment alternatives for this tumor may improve the outcome in patients with this stage of bladder cancer.
Literature of the last decade was comprehensively reviewed in regard to clinical and pathological diagnosis, adjuvant treatments, prognosis, and the role and timing of cystectomy. The information was gathered from MEDLINE, current urology journals, abstracts from recent urological meetings and personal experience.
High grade and the depth of lamina propria invasion are important prognostic factors. Early diagnosis and accurate pathological assessment are essential for determining the most adequate treatment pathway. Initial treatment consists of complete transurethral resection and adjuvant treatment with intravesical instillation of bacillus Calmette-Guerin (BCG). Immediate postoperative instillation of mitomycin C decreases the risk of recurrence possibly related to tumor implantation. Intravesical treatment does not substantially decrease the chance of progression. Lack of a complete response to BCG at 3 to 6 months, high grade, the depth of lamina propria invasion, the association of carcinoma in situ and prostate mucosa or duct involvement represent significant predictors for progression. Cystectomy should be suggested for recurrent stage T1 tumor after BCG, new onset or persistent carcinoma in situ, tumor located at a difficult site for resection, prostatic duct or stromal involvement and muscle invasion.
High grade stage T1 transitional cell carcinoma is a highly malignant tumor. Complete resection followed by immediate mitomycin C instillation and 6 weekly BCG instillations results in an acceptably low recurrence and progression rate. Rigorous long-term surveillance and continuous reconsideration of radical cystectomy in concordance with the evolution of the disease are essential.
累及固有层的移行细胞癌（T1期）具有较高的复发和进展率，对患者的生存和生活质量有影响。更好地了解该肿瘤的自然史和治疗选择可能会改善此阶段膀胱癌患者的预后。
全面回顾了过去十年关于临床和病理诊断、辅助治疗、预后以及膀胱切除术的作用和时机的文献。信息收集自MEDLINE、当前的泌尿学杂志、近期泌尿学会议的摘要以及个人经验。
高级别和固有层浸润深度是重要的预后因素。早期诊断和准确的病理评估对于确定最合适的治疗途径至关重要。初始治疗包括经尿道完全切除，并膀胱内灌注卡介苗（BCG）进行辅助治疗。术后立即灌注丝裂霉素C可降低可能与肿瘤种植相关的复发风险。膀胱内治疗并不能显著降低进展的几率。在3至6个月时对BCG无完全反应、高级别、固有层浸润深度、原位癌与前列腺黏膜或导管受累的关联是进展的重要预测因素。对于BCG治疗后复发的T1期肿瘤、新发或持续性原位癌、位于难以切除部位的肿瘤、前列腺导管或基质受累以及肌肉浸润，应建议行膀胱切除术。
高级别T1期移行细胞癌是一种高度恶性的肿瘤。完全切除后立即灌注丝裂霉素C并每周进行6次BCG灌注可使复发和进展率低至可接受水平。严格的长期监测以及根据疾病进展持续重新考虑根治性膀胱切除术至关重要。
