Takashi M, Sakata T, Murase T, Hamajima N, Miyake K
Department of Urology, Nagoya University School of Medicine, Japan.
Nagoya J Med Sci. 1991 Mar;53(1-4):1-8.
To determine the clinical characteristics of grade 3 tumors with lamina propria invasion (pT1), we reviewed the data of 217 patients with superficial bladder cancer who had initially been treated by transurethral resection (193 patients) and fulguration (4), supravesical resection (13) or partial cystectomy (7). We classified the patients into four groups according to histological grade and stage of disease: group 1) grade 0 or 1, pTa tumors (n = 58); group 2) grade 2, pTa tumors (n = 106); group 3) grade 2, pT1 tumors (n = 30); and group 4a) grade 3, pT1 tumors (n = 23). Grade 3, pT1 tumors were significantly related to nonpapillary growth (p = 0.0002), multiple tumors (p = 0.005) and irritative bladder symptoms (p = 0.01). The 5-year progression rates were 0% for group 1, 5% for group 2, 8% for group 3, and 18% for group 4a. The respective 5-year survival rates were 97%, 91%, 83% and 79%. All five patients with grade 3, pT1 tumors who had originally undergone total cystectomy (group 4b) remained alive free of disease for a median follow-up 57 months, establishing a far better survival rate than that for group 4a. These findings show that patients with grade 3, pT1 tumors face a high probability of progression and poor chance of survival. Immediate radical treatment is indicated when tumors recur after initial transurethral resection.
为确定伴有固有层浸润的3级肿瘤（pT1）的临床特征，我们回顾了217例浅表性膀胱癌患者的数据，这些患者最初接受了经尿道切除术（193例）、电灼术（4例）、膀胱上切除术（13例）或部分膀胱切除术（7例）。我们根据疾病的组织学分级和分期将患者分为四组：第1组）0级或1级，pTa肿瘤（n = 58）；第2组）2级，pTa肿瘤（n = 106）；第3组）2级，pT1肿瘤（n = 30）；第4a组）3级，pT1肿瘤（n = 23）。3级pT1肿瘤与非乳头状生长（p = 0.0002）、多发肿瘤（p = 0.005）和膀胱刺激症状（p = 0.01）显著相关。第1组的5年进展率为0%，第2组为5%，第3组为8%，第4a组为18%。各自的5年生存率分别为97%、91%、83%和79%。最初接受全膀胱切除术的所有5例3级pT1肿瘤患者（第4b组）在中位随访57个月时均存活且无疾病复发，其生存率远高于第4a组。这些发现表明，3级pT1肿瘤患者进展概率高且生存机会差。当初始经尿道切除术后肿瘤复发时，应立即进行根治性治疗。
