Solsona E, Iborra I, Rubio J, Casanova J, Dumont R, Monrós J L
Department of Urology, Instituto Valenciano de Oncologi;a, C/Prof. Beltrán Baguena 8, 46009, Valencia, Spain.
Eur Urol. 2003 May;43(5):489-94. doi: 10.1016/s0302-2838(03)00100-3.
To evaluate the prognoses and predictive factors of late oncological occurrences and its impact on follow-up strategy in patients with bladder tumours treated with radical cystectomy.
Late oncological occurrences were considered when they took place after three years from cystectomy or when early recurrence was controlled with therapy and patients developed recurrence again after a three-year disease-free interval. Univariate and multivariate analysis of predictive factors for late oncological occurrences were carried out on 215 patients at risk of late oncological recurrences.
Among 357 patients treated with cystectomy, 163 (45.6%) relapsed, 149 (41.7%) of them as early recurrence and 17 (4.7%) were considered as late oncological events. This incidence increased up to 8% when patients at risk were considered. Three patients with early recurrence reached a complete response after treatment and relapsed again as late recurrences. Distant metastases and local recurrence represented 78.5% of early recurrence as opposed to 11.7% in late oncological occurrences, whereas, extravesical urothelium recurrences represented 8.6% and 70% respectively (p<0.01). Among patients with late oncological occurrences, nine (53%) were disease-free, seven with urothelial recurrence and two of three with lymph-node recurrence whereas only eight (5.6%) patients with early recurrence were free of tumour (p<0.0001). Multiple tumours, prostate involvement and organ-confined tumours in cystectomy specimen were the independent variables for predicting late oncological occurrences in multivariate analysis.
Recurrences in the remaining urothelium prevail as the pattern of late oncological occurrences. The prognosis of these events is significantly better than an early recurrence. Patients at risk of late oncological occurrences are those with multiple tumours, prostate involvement and with organ-confined tumours in cystectomy specimen. After three years from cystectomy, the follow-up schedule of these patients be limited to performing an annual CT-scan and urinary cytology to detect essentially upper urinary tract recurrence and extrapelvic lymph-nodal recurrence. Afterwards an annual intravenous urography might replace to CT-scan since lymph-nodal involvement was not detected.
评估接受根治性膀胱切除术的膀胱肿瘤患者晚期肿瘤复发的预后、预测因素及其对随访策略的影响。
晚期肿瘤复发是指在膀胱切除术后三年后发生，或早期复发经治疗得到控制且患者在无病间隔三年后再次复发的情况。对215例有晚期肿瘤复发风险的患者进行了晚期肿瘤复发预测因素的单因素和多因素分析。
在357例行膀胱切除术的患者中，163例（45.6%）复发，其中149例（41.7%）为早期复发，17例（4.7%）被视为晚期肿瘤事件。若考虑有风险的患者，这一发生率增至8%。3例早期复发患者经治疗后达到完全缓解，随后又复发为晚期复发。远处转移和局部复发占早期复发的78.5%，而在晚期肿瘤复发中占11.7%，膀胱外尿路上皮复发分别占8.6%和70%（p<0.01）。在晚期肿瘤复发患者中，9例（53%）无病，7例为尿路上皮复发，3例中有2例为淋巴结复发，而早期复发患者中只有8例（5.6%）无肿瘤（p<0.0001）。多肿瘤、前列腺受累以及膀胱切除标本中的器官局限性肿瘤是多因素分析中预测晚期肿瘤复发的独立变量。
剩余尿路上皮复发是晚期肿瘤复发的主要模式。这些事件的预后明显优于早期复发。有晚期肿瘤复发风险的患者是那些有多肿瘤、前列腺受累以及膀胱切除标本中有器官局限性肿瘤的患者。膀胱切除术后三年后，这些患者的随访计划应限于每年进行一次CT扫描和尿液细胞学检查，以主要检测上尿路复发和盆腔外淋巴结复发。此后，由于未检测到淋巴结受累，每年的静脉肾盂造影可替代CT扫描。
