Kamat Ashish M, Gee Jason R, Dinney Colin P N, Grossman H Barton, Swanson David A, Millikan Randall E, Detry Michelle A, Robinson Tracy L, Pisters Louis L
Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, 77030, USA.
J Urol. 2006 Mar;175(3 Pt 1):881-5. doi: 10.1016/S0022-5347(05)00423-4.
Micropapillary bladder carcinoma is a rare variant of UC. Due to paucity of data regarding treatment outcomes, patients with nonmuscle invasive micropapillary UC often receive intravesical therapy in an attempt at bladder preservation.
We reviewed the records of all patients evaluated at our institution who had micropapillary UC of the bladder. Of these, 44 had nonmuscle invasive disease at presentation and form the basis of this report.
Mean patient age was 64.3 years (range 45 to 81) with a male-to-female ratio of 13:1. Stage distribution at presentation was 5 Ta (11%), 4 CIS (9%) and 35 T1 (80%). Median CSS was 81 months. Kaplan-Meier estimates of 5 and 10-year CSS rates were 64% and 26%, respectively. Intravesical BCG therapy was attempted in 27 patients (61%). Of these 27 patients, 67% (18 of 27) had progression (cT2 or greater), including 22% in whom metastatic disease developed. Only 19% of patients (5 of 27, all T1) remain disease-free with an intact bladder at a median followup of 30 months. A total of 30 patients (68%) underwent cystectomy. Among patients who underwent cystectomy after progression (18), median CSS was 61.7 months with no patient surviving 10 years, whereas among those undergoing cystectomy as initial therapy (12), median survival was not reached and the 10-year CSS rate was 72%.
Intravesical BCG therapy appears to be ineffective against micropapillary UC. Our results suggest that the optimal treatment strategy for nonmuscle invasive micropapillary UC is radical cystectomy performed before progression.
微乳头型膀胱癌是尿路上皮癌的一种罕见变体。由于关于治疗结果的数据较少，非肌层浸润性微乳头型尿路上皮癌患者常接受膀胱内治疗以试图保留膀胱。
我们回顾了在我们机构评估的所有患有膀胱微乳头型尿路上皮癌患者的记录。其中，44例患者初诊时为非肌层浸润性疾病，构成本报告的基础。
患者平均年龄为64.3岁（范围45至81岁），男女比例为13:1。初诊时的分期分布为5例Ta期（11%）、4例原位癌（CIS，9%）和35例T1期（80%）。中位无进展生存期（CSS）为81个月。采用Kaplan-Meier法估计的5年和10年CSS率分别为64%和26%。27例患者（61%）尝试了膀胱内卡介苗（BCG）治疗。在这27例患者中，67%（27例中的18例）出现进展（cT2或更高分期），其中22%发生了转移性疾病。在中位随访30个月时，仅19%的患者（27例中的5例，均为T1期）膀胱完整且无疾病。共有30例患者（68%）接受了膀胱切除术。在进展后接受膀胱切除术的患者（18例）中，中位CSS为61.7个月，无患者存活10年；而作为初始治疗接受膀胱切除术的患者（12例），未达到中位生存期，10年CSS率为72%。
膀胱内BCG治疗似乎对微乳头型尿路上皮癌无效。我们的结果表明，非肌层浸润性微乳头型尿路上皮癌的最佳治疗策略是在进展前进行根治性膀胱切除术。
