Millar Jeremy L, Frydenberg Mark, Toner Guy, Syme Rodney, Thursfield Vicky, Giles Graham G
William Buckland Radiotherapy Centre, The Alfred Hospital, Victoria, Australia.
ANZ J Surg. 2006 Mar;76(3):113-9. doi: 10.1111/j.1445-2197.2006.03665.x.
The management and outcomes of muscle-invasive bladder cancer are described in this article.
A retrospective survey of medical practitioners involved in the management of bladder cancer was conducted. The survey obtained at least 5 years of follow-up data on all patients. The sample was taken from the public and private health sectors in Victoria. All were cases of muscle-invasive bladder cancer diagnosed between 1990 and 1995. The main outcome measures included reported management by staging, treatment and survival.
Completed questionnaires were returned for 743 (89.6%) of 829 cases. Of these, 523 (70.4%) were men, and the mean age was 72.7 years. More than 75% of the cases (560) presented with macroscopic haematuria. The majority (696, 94%) had transitional cell carcinoma. A variety of treatments were given in various sequences, with 231 cases (31.1%) having initial surveillance. Eventually, 303 cases (40.8%) proceeded to 'definitive' management with either radiotherapy (132, 17.8%) or cystectomy (171, 23.0%). In addition, chemotherapy was given to 254 patients (34.2%) at some time. Most patients (613, 82.5%) have subsequently died; 402 (54%) died from bladder cancer. Crude 5-year survival was 13.0%, and disease-specific survival was 27.7%. Multivariate analysis identified the following predictors of greater disease-specific survival: grade 1 or 2 histopathology (P = 0.0003), T2 primary (P < 0.0001), N0 disease (P = 0.04), M0 disease (P < 0.0001), radiation dose in BED(10) >70 Gy and cystectomy (P < 0.0001).
Muscle-invasive bladder cancer in Victoria typically occurs in elderly patients, and a notable proportion of these patients do not proceed onto 'definitive' treatment. Disease stage, cystectomy and the use of high doses of radiation are associated with better outcomes. Chemotherapy was given to approximately one-third of patients at some point in their disease management. Our data are similar to population-based data from North America, and provide a baseline against which potential changes in management of bladder cancer can be compared.
本文描述了肌层浸润性膀胱癌的管理及治疗结果。
对参与膀胱癌管理的医生进行了一项回顾性调查。该调查获取了所有患者至少5年的随访数据。样本取自维多利亚州的公共和私营卫生部门。所有病例均为1990年至1995年间诊断的肌层浸润性膀胱癌。主要观察指标包括按分期报告的管理、治疗和生存情况。
829例中有743例（89.6%）返回了完整的调查问卷。其中，523例（70.4%）为男性，平均年龄为72.7岁。超过75%的病例（560例）出现肉眼血尿。大多数（696例，94%）为移行细胞癌。采用了各种不同顺序的治疗方法，231例（31.1%）最初进行观察。最终，303例（40.8%）接受了“确定性”治疗，其中放疗（132例，17.8%）或膀胱切除术（171例，23.0%）。此外，254例患者（34.2%）在病程中的某个阶段接受了化疗。大多数患者（613例，82.5%）随后死亡；402例（54%）死于膀胱癌。5年粗生存率为13.0%，疾病特异性生存率为27.7%。多变量分析确定了以下疾病特异性生存率较高的预测因素：组织病理学1级或2级（P = 0.0003）、T2期原发肿瘤（P < 0.0001）、N0期疾病（P = 0.04）、M0期疾病（P < 0.0001）、等效生物剂量（BED）（10）中的辐射剂量>70 Gy以及膀胱切除术（P < 0.0001）。
维多利亚州的肌层浸润性膀胱癌通常发生在老年患者中，这些患者中有相当一部分未接受“确定性”治疗。疾病分期、膀胱切除术和高剂量放疗与更好的治疗结果相关。约三分之一的患者在疾病管理的某个阶段接受了化疗。我们的数据与来自北美的基于人群的数据相似，并提供了一个基线，可据此比较膀胱癌管理方面的潜在变化。
