Herr Harry W, Donat S Machele, Dalbagni Guido
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
J Urol. 2007 Jan;177(1):75-9; discussion 79. doi: 10.1016/j.juro.2006.08.070.
We determined whether pathological findings on restaging transurethral resection predict early stage progression of T1 bladder cancer.
A cohort of 352 patients presenting with T1 bladder cancer on initial transurethral resection was evaluated by second or restaging transurethral resection. All patients received bacillus Calmette-Guerin therapy and 88% were followed for 5 years. Pathological findings on restaging transurethral resection were correlated with tumor features, stage progression frequency and progression-free survival.
Of the 352 patients with T1 tumors 203 (58%) had residual tumor on restaging transurethral resection, including 92 (26%) with residual nonmuscle invasive (T1) cancer. During 5 years 66% of cases recurred and 35% progressed in stage. Of the 92 patients with residual T1 cancer 75 (82%) progressed to muscle invasion within 5 years compared to 49 of 260 (19%) who had no or nonT1 tumor detected on restaging transurethral resection.
Restaging transurethral resection identifies patients with T1 bladder cancer who are at high risk for early tumor progression, justifying immediate cystectomy.
我们确定了再次经尿道切除术的病理结果是否能预测T1期膀胱癌的早期进展。
对352例初次经尿道切除术后诊断为T1期膀胱癌的患者进行了二次或再次经尿道切除术评估。所有患者均接受卡介苗治疗，88%的患者随访了5年。再次经尿道切除术的病理结果与肿瘤特征、分期进展频率和无进展生存期相关。
352例T1期肿瘤患者中，203例（58%）在再次经尿道切除术中发现有残留肿瘤，其中92例（26%）为残留非肌层浸润性（T1）癌。5年内，66%的病例复发，35%的病例分期进展。92例残留T1期癌患者中，75例（82%）在5年内进展为肌层浸润，而260例再次经尿道切除术中未发现肿瘤或非T1期肿瘤的患者中，有49例（19%）进展为肌层浸润。
再次经尿道切除术可识别出T1期膀胱癌早期肿瘤进展风险高的患者，证明应立即行膀胱切除术。
