Canales Benjamin K, Anderson James K, Premoli Juan, Slaton Joel W
Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
J Urol. 2006 Jan;175(1):74-7. doi: 10.1016/S0022-5347(05)00071-6.
While the evidence is clear that patients with carcinoma in situ or high grade T1 TCC of the bladder are at higher risk for developing UUT tumors, the role of imaging the UUT in patients with Ta tumors remains controversial. We hypothesized that the number and frequency of recurrences in patients with Ta disease would allow us to identify a population who should undergo routine UUT surveillance.
We reviewed our database of 375 patients who underwent resection of a stage Ta TCC between 1975 and 1995. Median followup was 6 years. Patients were stratified according to the presence of an UUT occurrence, rate and timing of superficial recurrences, and grade of the initial bladder tumor.
Among the 375 patients 50% had no bladder recurrence, 25% had 1 tumor, 15% had 2 tumors, and 10% had 3 or more tumors. Average time between tumors was 17 months. UUT tumor developed in 13 patients (3.4%) at an average of 22 months after their initial bladder tumor. A high risk group consisting of patients who had 2 or more bladder recurrences recurring within 12 months of each other were at 4.5-fold the risk of UUT tumor.
Stage Ta bladder cancer patients with 2 or more recurrences of bladder tumors with a median of less than 12 months between recurrences are at higher risk for developing an UUT tumor and should be considered for more frequent UUT surveillance.
虽然有明确证据表明膀胱原位癌或高级别T1期移行细胞癌（TCC）患者发生上尿路（UUT）肿瘤的风险更高，但对于Ta期肿瘤患者进行UUT成像的作用仍存在争议。我们假设Ta期疾病患者的复发次数和频率将使我们能够识别出应接受常规UUT监测的人群。
我们回顾了1975年至1995年间接受Ta期TCC切除术的375例患者的数据库。中位随访时间为6年。根据UUT病变的存在情况、浅表复发的发生率和时间以及初始膀胱肿瘤的分级对患者进行分层。
在375例患者中，50%无膀胱复发，25%有1个肿瘤，15%有2个肿瘤，10%有3个或更多肿瘤。肿瘤之间的平均时间间隔为17个月。13例患者（3.4%）出现UUT肿瘤，平均在其初始膀胱肿瘤后22个月。一个高危组由那些在12个月内有2次或更多次膀胱复发的患者组成，他们发生UUT肿瘤的风险是其他患者的4.5倍。
Ta期膀胱癌患者如果有2次或更多次膀胱肿瘤复发，且复发间隔中位数小于12个月，则发生UUT肿瘤的风险更高，应考虑更频繁地进行UUT监测。
