Smaldone Marc C, Jacobs Bruce L, Smaldone Arlene M, Hrebinko Ronald L
Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Urology. 2008 Sep;72(3):613-6. doi: 10.1016/j.urology.2008.04.052. Epub 2008 Jun 13.
We reviewed our experience with partial cystectomy to assess local control and survival rates, and to identify pathologic predictors for recurrence.
From 1995 to 2005, 25 patients with urothelial carcinoma underwent partial cystectomy with curative intent. As protocol, patients with primary solitary muscle-invasive bladder tumors underwent preoperative localized radiotherapy, administration of a single dose of intravesical chemotherapy at the time of partial cystectomy, and postoperative intravesical Bacillus Calmette-Guérin therapy. We reviewed clinical and pathologic data to identify variables associated with disease recurrence.
We analyzed data from 25 patient records meeting review criteria (72% male, mean age 65.1 +/- 9.8 years). At time of transurethral resection of a bladder tumor (TURBT), all had a solitary primary T2 (68%) or T1HG (32%) lesion with no evidence of carcinoma in situ. At follow-up (mean 45.3 +/- 30.7 months), 5-year recurrence-free, disease-specific, and overall survival rates were 64%, 84%, and 70%, respectively. At a mean of 18.0 +/- 15.6 months, 8% of patients experienced intravesical non-muscle-invasive tumor recurrences and were treated with TURBT and intravesical chemotherapy. Twenty percent recurred with locally advanced tumors or visceral metastasis and were treated with systemic chemotherapy, local resection or cystectomy, or both. On univariate analysis, only tumor size at time of partial cystectomy (P = .03) was significantly associated with tumor recurrence.
Partial cystectomy offers adequate control of localized invasive urothelial carcinoma in carefully selected patients with solitary primary tumors. Lifelong follow-up with cystoscopy and abdominal imaging is recommended to detect recurrence.
我们回顾了我们的部分膀胱切除术经验，以评估局部控制率和生存率，并确定复发的病理预测因素。
1995年至2005年，25例尿路上皮癌患者接受了根治性部分膀胱切除术。按照方案，原发性孤立性肌肉浸润性膀胱肿瘤患者接受术前局部放疗、部分膀胱切除术时单次膀胱内化疗以及术后膀胱内卡介苗治疗。我们回顾了临床和病理数据，以确定与疾病复发相关的变量。
我们分析了25份符合审查标准的患者记录数据（72%为男性，平均年龄65.1±9.8岁）。在经尿道膀胱肿瘤切除术（TURBT）时，所有患者均有孤立性原发性T2（68%）或T1HG（32%）病变，无原位癌证据。在随访（平均45.3±30.7个月）时，5年无复发生存率、疾病特异性生存率和总生存率分别为64%、84%和70%。平均18.0±15.6个月时，8%的患者出现膀胱内非肌肉浸润性肿瘤复发，接受了TURBT和膀胱内化疗。20%的患者出现局部晚期肿瘤或内脏转移复发，接受了全身化疗、局部切除或膀胱切除术，或两者兼而有之。单因素分析显示，仅部分膀胱切除术时的肿瘤大小（P = .03）与肿瘤复发显著相关。
对于精心挑选的孤立性原发性肿瘤患者，部分膀胱切除术可对局限性浸润性尿路上皮癌提供充分控制。建议进行终身膀胱镜检查和腹部影像学随访以检测复发。
