Raj Ganesh V, Bochner Bernard H, Serio Angel M, Vickers Andrew, Donat S Machele, Herr Harry, Lin Oscar, Dalbagni Guido
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
J Urol. 2006 Nov;176(5):2000-5; discussion 2005. doi: 10.1016/j.juro.2006.07.049.
The natural history and risk of disease progression in patients with positive urine cytology after radical cystectomy for urothelial carcinoma has not been adequately elucidated.
An institutional review board approved, retrospective review in patients undergoing radical cystectomy was performed to identify those with positive urinary cytology after radical cystectomy. Cox proportional hazards regression was used to determine factors associated with positive cytology after radical cystectomy and upper tract recurrence after positive cytology. Survival curves and probabilities were examined by Kaplan-Meier analysis.
A total of 101 patients with at least a single positive urinary cytology result after radical cystectomy were identified. Ureteral involvement in the radical cystectomy specimen was significantly associated with subsequent positive cytology. At the first positive urinary cytology only 9 of 101 patients (9%) had documented urothelial recurrence but eventually 57 of 101 had radiographic evidence of urothelial recurrence. Median freedom from radiological evidence of urothelial recurrence after positive cytology was 2.1 years and ureteral involvement was associated with a higher likelihood of urothelial recurrence. Despite surgical and chemotherapeutic interventions median survival after urothelial recurrence was 2.1 years.
Urine cytology may have a valuable role for detecting upper tract recurrence after radical cystectomy. Most patients with positive cytology after radical cystectomy eventually have radiological evidence of urothelial recurrence. These data may help clarify natural history in patients with positive cytology after radical cystectomy. Additionally, these data indicate the need for diligent evaluation for recurrent disease and potentially the role of early adjuvant therapy in patients with positive cytology after radical cystectomy.
根治性膀胱切除术后尿细胞学检查阳性的尿路上皮癌患者的疾病自然史和进展风险尚未得到充分阐明。
对接受根治性膀胱切除术的患者进行机构审查委员会批准的回顾性研究，以确定根治性膀胱切除术后尿细胞学检查阳性的患者。采用Cox比例风险回归分析来确定与根治性膀胱切除术后细胞学检查阳性及细胞学检查阳性后上尿路复发相关的因素。通过Kaplan-Meier分析检查生存曲线和概率。
共识别出101例根治性膀胱切除术后至少有一次尿细胞学检查结果为阳性的患者。根治性膀胱切除标本中的输尿管受累与随后的细胞学检查阳性显著相关。在首次尿细胞学检查阳性时，101例患者中只有9例（9%）有记录的尿路上皮复发，但最终101例中有57例有尿路上皮复发的影像学证据。细胞学检查阳性后无尿路上皮复发影像学证据的中位时间为2.1年，输尿管受累与尿路上皮复发的可能性更高相关。尽管进行了手术和化疗干预，但尿路上皮复发后的中位生存期为2.1年。
尿细胞学检查在检测根治性膀胱切除术后上尿路复发方面可能具有重要作用。大多数根治性膀胱切除术后细胞学检查阳性的患者最终会有尿路上皮复发的影像学证据。这些数据可能有助于阐明根治性膀胱切除术后细胞学检查阳性患者的自然史。此外，这些数据表明需要对复发性疾病进行仔细评估，并可能需要对根治性膀胱切除术后细胞学检查阳性的患者进行早期辅助治疗。
