Khaled Hussein, El Hattab Omar, Moneim Doaa Abdel, Kassem Hatem Aboul, Morsi Ahmed, Sherif Ghada, Darwish Tarek, Gaafar Rabab
Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.
Urol Oncol. 2005 Jul-Aug;23(4):254-60. doi: 10.1016/j.urolonc.2005.04.005.
Bladder cancer is still the most common solid tumor among adult males in Egypt because of the prevalence of bilharzial infestation, especially in the countryside. In this prospective study, we have recorded the prognostic factors for 180 patients with invasive bladder cancer for whom standard radical cystectomy had been performed to develop a prognostic index (bladder prognostic index) that defines high risk patients who are more vulnerable to disease relapse after surgery and who may benefit from additional therapy.
The study was performed between January 1997 and December 1999, in which 180 patients with histopathologically proved invasive bladder cancer associated with bilharziasis underwent radical cystectomy or anterior pelvic exenteration. After surgery, patients were regularly followed for a minimum of 2 years.
Our patients included 141 males and 39 females. Squamous cell carcinoma was the most common type (53.3%), and most of the tumors were grade II (61.1%). A total of 173 patients had their tumors operable, while 7 were inoperable. We had 5 (2.8%) operative related mortalities. At 5 years postoperatively, free and overall survival rates for the whole group of patients were 31.44%+/-5.9% and 32.5%+/-6.8%, respectively. Tumor pathologic stage, grade, and nodal affection were the only significant factors with impact on survival (P=0.008, 0.051, and 0.004, respectively). These 3 prognostic indexes were used to design a model to predict an individual patient's risk factor for recurrence. Patients were then assigned to one of the 4 risk groups according to the score achieved in this prognostic index (0=low risk, 1=intermediate risk, and 2 or 3=higher risk). These 4 risk groups had distinctly different rates of disease-free survival, i.e., 91.7%, 53%, 13%, and 7% for low, intermediate, and higher risk groups, respectively.
Although this prognostic index appears to be of a significant clinical relevance, it needs to be more validated on a larger number of patients, and it could be a surrogate variable for biologic factors responsible for the heterogeneity of bladder cancer.
由于埃及尤其是农村地区血吸虫感染率高，膀胱癌仍是成年男性中最常见的实体瘤。在这项前瞻性研究中，我们记录了180例行标准根治性膀胱切除术的浸润性膀胱癌患者的预后因素，以制定一个预后指数（膀胱预后指数），该指数可定义出术后疾病复发风险较高且可能从额外治疗中获益的高危患者。
该研究于1997年1月至1999年12月进行，180例经组织病理学证实为与血吸虫病相关的浸润性膀胱癌患者接受了根治性膀胱切除术或前盆腔脏器清除术。术后，患者接受至少2年的定期随访。
我们的患者包括141名男性和39名女性。鳞状细胞癌是最常见的类型（53.3%），大多数肿瘤为Ⅱ级（61.1%）。共有173例患者的肿瘤可切除，7例不可切除。我们有5例（2.8%）手术相关死亡病例。术后5年，全组患者的无瘤生存率和总生存率分别为31.44%±5.9%和32.5%±&6.8%。肿瘤病理分期、分级和淋巴结受累是影响生存的仅有的显著因素（P分别为0.008、0.051和0.004）。这3个预后指标用于设计一个模型来预测个体患者的复发风险因素。然后根据该预后指数所获分数将患者分为4个风险组之一（0=低风险，1=中度风险，2或3=高风险）。这4个风险组的无病生存率明显不同(，即低、中、高风险组分别为91.7%、53%、13%和7%。
尽管这个预后指数似乎具有显著的临床相关性，但它需要在更多患者中进行进一步验证，并且它可能是导致膀胱癌异质性的生物学因素的替代变量。
