Sözen Sinan, Akbal Cem, Sökmensüer Cenk, Ekici Sinan, Ozen Haluk
Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.
Urol Int. 2002;69(3):200-6. doi: 10.1159/000063941.
Our objective was to evaluate the feasibility and value of microstaging in pT1 transitional cell carcinoma (TCC) of the bladder in a well-defined group of patients treated with transurethral resection (TUR) only.
The clinical records of 152 patients who underwent TUR for the treatment of primary superficial TCC of the bladder between 1983 and 1997 were reviewed. Patients with primary carcinoma in situ and who received adjuvant intravesical treatments were excluded from study. We subclassified the pT1 tumors into two groups according to muscularis mucosae (MM) invasion (pT1 and pT1b). The recurrence and progression rate of cancers was analyzed according to the stage, grade, multiplicity and tumor size. Mean follow-up was 68 months. Estimation of the cumulative distribution of the disease-free interval in separate groups was calculated according to the Kaplan-Meier method. Multivariate analysis of the data was performed by using Cox regression method. A value of p < 0.05 was taken to be statistically significant with odds ratios.
Of the 152 patients, tumor stage was pTa in 62 (40.8%) patients and pT1 in 90 (59.2%) patients. Among those pT1 tumors, MM was identified in 50 (55.5%) of cases (pT1a = 34, pT1b = 16). In the remaining 40 (44.5%) patients, MM could not be assessed. Kaplan-Meier analysis revealed that recurrence and progression were statistically significant for stage, multiplicity and grade of tumor. However, multivariate analysis revealed that stage was the only prognostic factor for recurrence and progression (p = 0.0001).
The present study underscores the fact that pT1b tumors have a distinct natural history. If initial conservative treatment is selected, the patients must be followed very cautiously.
我们的目的是评估在仅接受经尿道切除术（TUR）治疗的一组明确患者中，对膀胱pT1期移行细胞癌（TCC）进行微分期的可行性和价值。
回顾了1983年至1997年间因原发性浅表性膀胱TCC接受TUR治疗的152例患者的临床记录。原位癌患者及接受辅助膀胱内治疗的患者被排除在研究之外。我们根据黏膜肌层（MM）浸润情况将pT1肿瘤分为两组（pT1和pT1b）。根据分期、分级、肿瘤多发情况和肿瘤大小分析癌症的复发率和进展率。平均随访时间为68个月。根据Kaplan-Meier方法计算不同组无病间期的累积分布估计值。使用Cox回归方法对数据进行多变量分析。p值<0.05被认为具有统计学意义，并给出优势比。
152例患者中，肿瘤分期为pTa的有62例（40.8%），pT1的有90例（59.2%）。在那些pT1肿瘤中，50例（55.5%）病例发现有MM浸润（pT1a = 34，pT1b = 16）。其余40例（44.5%）患者无法评估MM。Kaplan-Meier分析显示，肿瘤分期、多发情况和分级对复发和进展具有统计学意义。然而，多变量分析显示分期是复发和进展的唯一预后因素（p = 0.0001）。
本研究强调了pT1b肿瘤具有独特自然病程这一事实。如果选择初始保守治疗，必须非常谨慎地随访患者。
