Arce Jacobo, Gaya Josep M, Huguet Jorge, Rodriguez Oscar, Palou Joan, Villavicencio Humberto
Department of Urology, Fundacio Puigvert, Barcelona, Spain.
Can J Urol. 2011 Feb;18(1):5529-36.
To determine which patients may benefit from prostate-sparing surgery and which factors are predictive of invasive prostatic involvement.
A total of 717 men underwent radical cystoprostatectomy (RC) for bladder transitional cell carcinoma (TCC) between 1978 and 2002. Analysis of prostatic urethral involvement by transitional cell carcinoma (pTCC) and of invasive prostatic involvement by TCC was performed according to recurrence, presence of carcinoma in situ (CIS) and multifocality, previous intravesical chemotherapy, grade, stage and location of bladder tumor, presence of CIS in precystectomy transurethral resection (TUR) and indication for RC.
pTCC was present in specimens from 140 patients (19.5%), of whom 83 (59.3%) showed invasive prostatic involvement. Tumor location at the trigone or bladder neck (p = 0.011, OR 2.29, 95% CI 1.21-4.33) and a history of CIS (p = 0.003, OR 2.03, 95% CI 1.27-3.22) were independent predictors of pTCC. Presence of a solitary T2-T3 bladder tumor was a predictive factor for invasive prostatic involvement (p = 0.001, OR 3.73, 95% CI 1.70-8.16). Neither solitary tumors nor T2-T3 bladder tumors showed significant differences in 5 year specific survival (p = 0.277 and p = 0.618 respectively) when comparing patients according to the presence of superficial or invasive prostatic involvement. Bladder tumor stage in precystectomy TUR was a predictor of disease-specific survival (p = 0.018, OR 1.62, 95% CI 1.08-2.44).
Patients with a history of CIS and bladder tumor location at the trigone or bladder neck are not candidates for prostate-sparing surgery. The only variables that can predict invasive prostatic involvement are the presence of a solitary T2-T3 bladder tumor at the trigone or bladder neck.
确定哪些患者可能从保留前列腺手术中获益，以及哪些因素可预测前列腺浸润情况。
1978年至2002年间，共有717名男性因膀胱移行细胞癌（TCC）接受了根治性膀胱前列腺切除术（RC）。根据复发情况、原位癌（CIS）的存在及多灶性、既往膀胱内化疗、分级、分期及膀胱肿瘤位置、膀胱切除术前经尿道切除术（TUR）中CIS的存在情况以及RC的指征，对移行细胞癌累及前列腺尿道（pTCC）及TCC累及前列腺浸润情况进行分析。
140例患者（19.5%）的标本中存在pTCC，其中83例（59.3%）出现前列腺浸润。膀胱三角区或膀胱颈部的肿瘤位置（p = 0.011，OR 2.29，95% CI 1.21 - 4.33）和CIS病史（p = 0.003，OR 2.03，95% CI 1.27 - 3.22）是pTCC的独立预测因素。孤立的T2 - T3期膀胱肿瘤的存在是前列腺浸润的预测因素（p = 0.001，OR 3.73，95% CI 1.70 - 8.16）。根据前列腺浅表或浸润情况对患者进行比较时，孤立肿瘤和T2 - T3期膀胱肿瘤在5年特异性生存率方面均无显著差异（分别为p = 0.277和p = 0.618）。膀胱切除术前TUR中的膀胱肿瘤分期是疾病特异性生存的预测因素（p = 0.018，OR 1.62，95% CI 1.08 - 2.44）。
有CIS病史且膀胱肿瘤位于膀胱三角区或膀胱颈部的患者不适合保留前列腺手术。能够预测前列腺浸润的唯一变量是膀胱三角区或膀胱颈部存在孤立的T2 - T3期膀胱肿瘤。
