Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Munich, Germany.
J Urol. 2010 May;183(5):1757-63. doi: 10.1016/j.juro.2010.01.025. Epub 2010 Mar 17.
We describe the rate of up staging and the cancer specific outcomes of patients with carcinoma in situ refractory to transurethral resection with intravesical therapy treated with radical cystectomy.
The records of 3,207 patients treated with radical cystectomy for urothelial carcinoma of the bladder at 8 centers in the United States, Canada and Europe were reviewed.
Of the 3,207 patients who underwent radical cystectomy 243 (7.6%) had clinical carcinoma in situ only disease before radical cystectomy. At radical cystectomy 117 patients (48.1%) had carcinoma in situ only, 20 (8.2%) had pT0 urothelial carcinoma of the bladder, 19 (7.8%) had pTa urothelial carcinoma of the bladder and 36% had disease up staged (32 [13.2%] pT1, 29 [11.9%] pT2, 12 [4.9%] pT3 and 14 [5.8%] pT4). A total of 22 patients (9.1%) had lymphovascular invasion in the radical cystectomy specimen and 14 (5.8%) had metastasis to regional lymph nodes. Overall 5-year recurrence-free and cancer specific survival estimates were 74% (95% CI 68-79) and 85% (95% CI 80-89), respectively. On multivariable analysis adjusting for the effects of standard predictors, lymph node metastasis and lymphovascular invasion were associated with an increased risk of disease recurrence (p = 0.017 and p = 0.043, respectively) and cancer specific mortality (p = 0.019 and p = 0.001, respectively). Female gender was an independent risk factor for cancer specific mortality (p = 0.029) but not for disease recurrence (p = 0.173).
Approximately a fourth of patients treated with radical cystectomy for clinical carcinoma in situ only had muscle invasive disease and 5.8% had metastasis to regional lymph nodes. Identification of those patients with a potentially aggressive natural history of carcinoma in situ is of the utmost importance as they are likely to benefit from early radical cystectomy.
我们描述了经尿道切除联合膀胱内治疗后对原位癌无效的患者行根治性膀胱切除术的分期升级率和癌症特异性结局。
回顾了在美国、加拿大和欧洲 8 个中心接受根治性膀胱切除术治疗的 3207 例尿路上皮膀胱癌患者的记录。
在接受根治性膀胱切除术的 3207 例患者中，243 例（7.6%）在根治性膀胱切除术之前有临床原位癌。在根治性膀胱切除术中，117 例（48.1%）为单纯原位癌，20 例（8.2%）为 pT0 膀胱癌，19 例（7.8%）为 pTa 膀胱癌，36%为疾病升级（32 例[13.2%]pT1，29 例[11.9%]pT2，12 例[4.9%]pT3，14 例[5.8%]pT4）。根治性膀胱切除标本中共有 22 例（9.1%）有血管淋巴管侵犯，14 例（5.8%）有区域淋巴结转移。总的 5 年无复发生存率和癌症特异性生存率估计值分别为 74%（95%CI 68-79）和 85%（95%CI 80-89）。在多变量分析中，调整标准预测因素的影响后，淋巴结转移和血管淋巴管侵犯与疾病复发风险增加相关（p = 0.017 和 p = 0.043），与癌症特异性死亡率相关（p = 0.019 和 p = 0.001）。女性是癌症特异性死亡率的独立危险因素（p = 0.029），但与疾病复发无关（p = 0.173）。
约四分之一接受根治性膀胱切除术治疗的单纯临床原位癌患者有肌层浸润性疾病，5.8%有区域淋巴结转移。识别那些具有侵袭性原位癌自然史的患者非常重要，因为他们可能受益于早期根治性膀胱切除术。
