Department of Urology, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Munich, Germany.
J Urol. 2010 Sep;184(3):888-94. doi: 10.1016/j.juro.2010.04.081.
We describe the cancer related outcome in patients with pT0 bladder urothelial carcinoma at radical cystectomy who did not receive preoperative chemotherapy in a large multicenter series. We also compared outcomes in patients with pT0 bladder urothelial carcinoma to those in patients with other stages and assessed the effect of clinical stage on outcome.
We reviewed the records of 4,430 patients treated with radical cystectomy for bladder urothelial carcinoma without neoadjuvant chemotherapy at 12 centers in the United States, Canada and Europe.
Of the patients 228 (5.1%) had pT0 disease at radical cystectomy. Clinical stage was cTa or cTis in 13.6% and cT1 in 29.8% of these patients, and disease was muscle invasive (cT2-4a) in 56.2%. Metastasis developed to regional lymph nodes in 17 cases (7.5%). At a median 48.2-month followup 15 patients (6.6%) had died of bladder cancer. Five-year recurrence-free and cancer specific survival estimates were 89.7% (95% CI 85.3-93.1) and 93.1% (95% CI 88.9-95.6), respectively. Disease-free and cancer specific survival in pT0 cases was similar to that in pTa/pTis cases but significantly better than in pT1 or pT2 cases. On multivariate analysis increased disease recurrence and cancer specific mortality risks were significantly associated with lymph node metastasis (each p <0.001) and female gender (p <0.001 and 0.013, respectively).
Although stage pT0 at radical cystectomy confers a benefit in survival, some patients experience disease recurrence and eventual death. Identifying these patients may help tailor postoperative decision making in patients with pT0.
我们在一个大型多中心系列研究中描述了在根治性膀胱切除术时未接受术前化疗的 pT0 膀胱尿路上皮癌患者的癌症相关结局。我们还比较了 pT0 膀胱尿路上皮癌患者与其他分期患者的结局，并评估了临床分期对结局的影响。
我们回顾了在美国、加拿大和欧洲的 12 个中心接受根治性膀胱切除术治疗的 4430 例无新辅助化疗的膀胱尿路上皮癌患者的记录。
在这些患者中，228 例（5.1%）在根治性膀胱切除术中患有 pT0 疾病。临床分期为 cTa 或 cTis 的患者占 13.6%，cT1 的患者占 29.8%，疾病为肌层浸润性（cT2-4a）的患者占 56.2%。17 例（7.5%）出现区域淋巴结转移。在中位随访 48.2 个月时，15 例（6.6%）患者死于膀胱癌。5 年无复发生存率和癌症特异性生存率估计分别为 89.7%（95%CI 85.3-93.1）和 93.1%（95%CI 88.9-95.6）。pT0 病例的无病生存率和癌症特异性生存率与 pTa/pTis 病例相似，但明显优于 pT1 或 pT2 病例。多变量分析显示，疾病复发和癌症特异性死亡率的风险显著与淋巴结转移（均 p<0.001）和女性性别（分别为 p<0.001 和 p<0.013）相关。
尽管根治性膀胱切除术后的 pT0 分期可带来生存获益，但一些患者仍会出现疾病复发并最终死亡。识别这些患者可能有助于为 pT0 患者制定术后决策。
