Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
BJU Int. 2010 Dec;106(11):1657-61. doi: 10.1111/j.1464-410X.2010.09494.x.
To evaluate the prognostic impact of seminal vesicle invasion in men who underwent radical cystectomy for bladder cancer.
Of the 610 patients who underwent radical cystectomy for urothelial carcinoma of the bladder at our institution from 1989 to 2008, 60 male patients who had pathological stage T4 disease were divided into three groups: prostatic stromal invasion only (Group A, n= 35), seminal vesicle invasion regardless of prostatic stromal invasion (Group B, n= 19), and rectum or pelvic wall invasion (Group C, n= 6). We assessed the effect of several variables on recurrence-free survival (RFS) and cancer-specific survival (CSS).
The 2- and 5-year RFS rates for the entire cohort were 33.5% and 22.5%, respectively, and the 2- and 5-year CSS rates were 48.0% and 23.6%, respectively. Median RFS (6.6 months vs 26.3 months, P < 0.001) and CSS (14.5 months vs 35.9 months, P= 0.005) were significantly shorter for Group B than for Group A, but were similar in Groups B and C (6.6 months vs 8.8 months, P= 0.859 and 14.5 months vs 11.8 months, P= 0.613, respectively). On multivariate analysis, seminal vesicle invasion was an independent predictor of RFS (hazard ratio 2.94, 95% CI 1.40-6.17, P= 0.004) and CSS (2.63, 1.21-5.70, P= 0.014), along with pathological nodal status (3.90, 1.64-9.28, P= 0.002 and 4.39, 1.79-10.76, P= 0.001) and adjuvant therapy (2.76, 1.31-5.82, P= 0.008 and 4.14, 1.86-9.23, P= 0.001).
Seminal vesicle invasion by urothelial carcinoma of the bladder is a poor prognostic indicator for RFS and CSS. The prognosis of patients with seminal vesicle invasion mimics that of patients with pT4b bladder cancer.
评估膀胱癌根治性膀胱切除术后精囊受侵对男性患者预后的影响。
在我院，1989 年至 2008 年间，610 名接受根治性膀胱切除术治疗尿路上皮膀胱癌的患者中，60 名患有病理分期 T4 疾病的男性患者分为三组：单纯前列腺基质侵犯（A 组，n=35）、精囊侵犯而不论前列腺基质侵犯与否（B 组，n=19）、直肠或骨盆壁侵犯（C 组，n=6）。我们评估了几个变量对无复发生存率（RFS）和癌症特异性生存率（CSS）的影响。
整个队列的 2 年和 5 年 RFS 率分别为 33.5%和 22.5%，2 年和 5 年 CSS 率分别为 48.0%和 23.6%。B 组的中位 RFS（6.6 个月 vs 26.3 个月，P<0.001）和 CSS（14.5 个月 vs 35.9 个月，P=0.005）均明显短于 A 组，但 B 组和 C 组之间相似（6.6 个月 vs 8.8 个月，P=0.859 和 14.5 个月 vs 11.8 个月，P=0.613）。多因素分析显示，精囊侵犯是 RFS（危险比 2.94，95%CI 1.40-6.17，P=0.004）和 CSS（2.63，1.21-5.70，P=0.014）的独立预测因子，以及病理淋巴结状态（3.90，1.64-9.28，P=0.002 和 4.39，1.79-10.76，P=0.001）和辅助治疗（2.76，1.31-5.82，P=0.008 和 4.14，1.86-9.23，P=0.001）。
膀胱癌精囊受侵是 RFS 和 CSS 的预后不良指标。精囊受侵患者的预后类似于 pT4b 膀胱癌患者。
