Taher Azza N, Kotb Magdy H
Department of Radiation Oncology, National Cancer Institute, Cairo University, Egypt.
J Egypt Natl Canc Inst. 2006 Sep;18(3):203-8.
To address the necessity of incorporating isotopic bone scan in the routine staging work-up of muscle invasive bladder cancer patients, we analyzed the data in our files to determine the incidence of bone metastasis in such patients. The rate of subsequent development of bone metastasis along the natural history of the disease was also investigated.
A total of 179 files of consecutive bladder cancer patients who presented to the National Cancer Institute, Cairo University, between January 2000 and December 2001 were reviewed to check the percentage of positive bone scans on presentation and to check the subsequent development of distant metastases and bone metastasis in these patients' records.
Amongst the 179 patients, 26 (14.5%) had bone metastasis on presentation, a finding that showed a statistically significant correlation with the increasing depth of muscle invasion; 61.5% of the metastatic cases had deep muscle invasion,19.2% had superficial muscle invasion and there was no muscle invasion in 7.7% (p=0.000). Transitional cell carcinoma was the pathology in 92.3% of those patients, while only 7.7% had squamous cell carcinoma (p=0.036). The cumulative 3-year incidence of bone-metastasis in the non metastatic patients after treatment mounted to 19.4 +/- 4.4%. The cumulative 3-year bone metastasis incidence in the 153 patients was higher with increasing clinical stage; 8.4 +/- 8% for c-stage 2 and 49.1 +/- 18.5% for c-stage 4 (p=0.046). As for the p-category of the tumor in the 130 patients who underwent operation, the incidence increased with higher p-stages (p=0.006). Though pelvic nodal involvement was not associated with statistically significant increase in the incidence of bone metastases, yet when incorporated as one of the 3 risk factors (grade>3, p (3) 4a and LN positive at surgery) according to which patients were grouped, there was a statistically significant difference in the incidence between patients with no risk factors, only 1 and 2 or more factors (p=0.021).
Meticulous search for bone metastasis alone or as a component of distant failure in the newly diagnosed bladder cancer patients is crucial to offer them the proper management and avoid undue radical surgical procedures. Thus bone scan is suggested to be performed routinely in patients with evidence of muscle invasion.
为了探讨在肌肉浸润性膀胱癌患者的常规分期检查中纳入同位素骨扫描的必要性，我们分析了我们档案中的数据，以确定此类患者骨转移的发生率。同时还研究了疾病自然史中骨转移后续发生的比率。
回顾了2000年1月至2001年12月期间就诊于开罗大学国家癌症研究所的179例连续性膀胱癌患者的档案，以检查初诊时骨扫描阳性的百分比，并检查这些患者记录中远处转移和骨转移的后续发生情况。
在179例患者中，26例（14.5%）初诊时即有骨转移，这一发现与肌肉浸润深度增加具有统计学显著相关性；61.5%的转移病例有深部肌肉浸润，19.2%有浅部肌肉浸润，7.7%无肌肉浸润（p = 0.000）。这些患者中92.3%的病理类型为移行细胞癌，而只有7.7%为鳞状细胞癌（p = 0.036）。治疗后非转移患者骨转移的累积3年发生率升至19.4±4.4%。153例患者中，随着临床分期增加，累积3年骨转移发生率更高；c期2为8.4±8%，c期4为49.1±18.5%（p = 0.046）。对于接受手术的130例患者的肿瘤p分类，发生率随着p分期升高而增加（p = 0.006）。虽然盆腔淋巴结受累与骨转移发生率的统计学显著增加无关，但根据患者分组的3个风险因素（分级>3、p（3）4a和手术时淋巴结阳性）之一纳入时，无风险因素、仅有1个或2个及以上因素的患者之间的发生率存在统计学显著差异（p = 0.021）。
对新诊断的膀胱癌患者单独或作为远处失败的一部分进行细致的骨转移检查，对于为他们提供恰当的治疗并避免不必要的根治性手术至关重要。因此，建议对有肌肉浸润证据的患者常规进行骨扫描。
