Kassouf Wassim, Swanson David, Kamat Ashish M, Leibovici Dan, Siefker-Radtke Arlene, Munsell Mark F, Grossman H Barton, Dinney Colin P N
Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
J Urol. 2006 Jun;175(6):2058-62. doi: 10.1016/S0022-5347(06)00322-3.
Partial cystectomy is a surgical option for select patients diagnosed with urothelial carcinoma. We review our experience with partial cystectomy for muscle invasive urothelial carcinoma to assess local control and survival rates.
From 1982 to 2003 a total of 37 patients with muscle invasive urothelial carcinoma underwent partial cystectomy with curative intent. Reviewed data included history of superficial tumors, presence of variant histology, tumor location, clinical stage, pathological stage, presence of carcinoma in situ, adjuvant therapy and disease status.
The 5-year overall, disease specific and recurrence-free survival rates were 67%, 87% and 39%, respectively. Mean followup was 72.6 months (range 6 to 217). Of the 37 patients 19 (51%) did not have tumor recurrence, 9 (24%) had superficial recurrence in the bladder that was treated successfully and 9 (24%) had recurrence with advanced disease. A total of 24 patients (65%) had an intact bladder with no evidence of disease after a median of 53 months. There were 6 patients (16%) who died of bladder cancer, 3 of whom died of late recurrence of muscle invasive cancer (41, 44 and 138 months after partial cystectomy). On multivariate analysis higher pathological stage (HR 3.4, p = 0.04) was associated with shorter recurrence-free survival. A history of superficial tumors (p <0.01) and clinical stage (p = 0.01) was associated with advanced recurrence-free survival. The use of adjuvant chemotherapy (HR 0.18, p = 0.03) was associated with prolonged advanced recurrence-free survival, however adjuvant chemotherapy did not impact overall survival.
Partial cystectomy provides adequate local control of muscle invasive bladder cancer in select patients. Because late recurrence is not uncommon and is potentially life threatening, lifelong followup with cystoscopy is recommended.
部分膀胱切除术是诊断为尿路上皮癌的特定患者的一种手术选择。我们回顾了我们对肌肉浸润性尿路上皮癌行部分膀胱切除术的经验，以评估局部控制率和生存率。
1982年至2003年，共有37例肌肉浸润性尿路上皮癌患者接受了根治性部分膀胱切除术。回顾的数据包括浅表肿瘤病史、变异组织学的存在、肿瘤位置、临床分期、病理分期、原位癌的存在、辅助治疗和疾病状态。
5年总生存率、疾病特异性生存率和无复发生存率分别为67%、87%和39%。平均随访72.6个月（范围6至217个月）。37例患者中，19例（51%）无肿瘤复发，9例（24%）膀胱浅表复发且治疗成功，9例（24%）复发伴疾病进展。共有24例患者（65%）在中位时间53个月后膀胱完整且无疾病证据。6例患者（16%）死于膀胱癌，其中3例死于肌肉浸润性癌的晚期复发（部分膀胱切除术后41、44和138个月）。多因素分析显示，较高的病理分期（HR 3.4，p = 0.04）与较短的无复发生存期相关。浅表肿瘤病史（p <0.01）和临床分期（p = 0.01）与较长的无复发生存期相关。辅助化疗的使用（HR 0.18，p = 0.03）与延长的晚期无复发生存期相关，然而辅助化疗对总生存率无影响。
部分膀胱切除术可为特定患者的肌肉浸润性膀胱癌提供充分的局部控制。由于晚期复发并不罕见且可能危及生命，建议进行终身膀胱镜随访。
