Zecha Henrik, Schmid Hans-Peter, Tschopp Alois, Sulser Tullio, Engeler Daniel S
Department of Urology , St. Gallen Cantonal Hospital, St. Gallen , Switzerland.
Scand J Urol Nephrol. 2011 Sep;45(4):245-50. doi: 10.3109/00365599.2011.562234. Epub 2011 Mar 28.
The incidence of urogenital tumours is constantly increasing as a result of over-proportional ageing of the population in industrialized nations. Follow-up of non-muscle-invasive bladder cancer (NMIBC) primarily relies on the detection of either relapse or progression and does not include screening for second malignancies. This study investigated the incidence of independent non-urothelial second malignancies and associated risk factors in patients with NMIBC.
The charts of 380 consecutive patients (297 men and 83 women) with newly diagnosed NMIBC over a 16-year period at a Swiss hospital were analysed retrospectively. Age, stage of bladder tumour, smoking status, and occurrence of second and third malignancies were registered. Observed incidences of independent non-urothelial malignancies were compared with age- and gender-specific rates based on data from the National Institute for Cancer Epidemiology and Registration by calculating standardized incidence ratios (SIRs).
Mean age at first NMIBC diagnosis was 69.9 years. Histological stage of the NMIBC was pTa in 241 patients (63.4%), pT1 in 102 (26.8%)and pTis in 37 (9.7%). During follow-up, 62 independent non-urothelial second or third malignancies were observed in 48 men (16.2%) and 10 women (12.0%). In male patients, prostate and lung cancer (SIR 4.3 and 5.7, respectively) were more frequent than expected in the general population, as were lung and uterine cancer in women.
Follow-up in patients with NMIBC should pay special attention to independent non-urothelial malignancies. Investigations for non-urological malignant disease, especially for lung cancer, should form part of the standard follow-up in NMIBC patients.
由于工业化国家人口年龄的过度增长，泌尿生殖系统肿瘤的发病率持续上升。非肌层浸润性膀胱癌（NMIBC）的随访主要依赖于复发或进展的检测，不包括对第二原发恶性肿瘤的筛查。本研究调查了NMIBC患者中独立的非尿路上皮第二原发恶性肿瘤的发病率及相关危险因素。
回顾性分析了瑞士一家医院16年间连续收治的380例新诊断NMIBC患者（297例男性和83例女性）的病历。记录年龄、膀胱肿瘤分期、吸烟状况以及第二和第三原发恶性肿瘤的发生情况。根据国家癌症流行病学和登记研究所的数据，通过计算标准化发病比（SIR），将观察到的独立非尿路上皮恶性肿瘤的发病率与年龄和性别特异性发病率进行比较。
首次诊断NMIBC时的平均年龄为69.9岁。NMIBC的组织学分期为pTa的有241例患者（63.4%），pT1的有102例（26.8%），pTis的有37例（9.7%）。随访期间，48例男性（16.2%）和10例女性（12.0%）观察到62例独立的非尿路上皮第二或第三原发恶性肿瘤。在男性患者中，前列腺癌和肺癌（SIR分别为4.3和5.7）比一般人群中预期的更为常见，女性中肺癌和子宫癌也是如此。
NMIBC患者的随访应特别关注独立的非尿路上皮恶性肿瘤。对非泌尿系统恶性疾病的检查，尤其是肺癌，应成为NMIBC患者标准随访的一部分。
