根治性膀胱切除术治疗T1期膀胱癌：加拿大膀胱癌网络的经验。
Radical cystectomy for the treatment of T1 bladder cancer: the Canadian Bladder Cancer Network experience.
作者信息
Chalasani Venu, Kassouf Wassim, Chin Joseph L, Fradet Yves, Aprikian Armen G, Fairey Adrian S, Estey Eric, Lacombe Louis, Rendon Ricardo, Bell David, Cagiannos Ilias, Drachenberg Darrell, Lattouf Jean-Baptiste, Izawa Jonathan I
机构信息
Departments of Surgery & Oncology, Divisions of Urology & Surgical Oncology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON;
出版信息
Can Urol Assoc J. 2011 Apr;5(2):83-7. doi: 10.5489/cuaj.10040.
BACKGROUND
Radical cystectomy may provide optimal survival outcomes in the management of clinical T1 bladder cancer. We present our data from a large, multi-institutional, contemporary Canadian series of patients who underwent radical cystectomy for clinical T1 bladder cancer in a single-payer health care system.
METHODS
We collected a pooled database of 2287 patients who underwent radical cystectomy between 1993 and 2008 in 8 different centres across Canada; 306 of these patients had clinical T1 bladder cancer. Survival data were analyzed using Kaplan-Meier method and Cox regression analysis.
RESULTS
The median age of patients was 67 years with a mean follow-up time of 35 months. The 5-year overall, disease-specific and disease-free survival was 71%, 77% and 59%, respectively. The 10-year overall and disease-specific survival were 60% and 67%, respectively. Pathologic stage distribution was p0: 32 (11%), pT1: 78 (26%), pT2: 55 (19%), pT3: 60 (20%), pT4: 27 (9%), pTa: 16 (5%), pTis: 28 (10%), pN0: 215 (74%) and pN1-3: 78 (26%). Only 12% of patients were given adjuvant chemotherapy. On multivariate analysis, only margin status and pN stage were independently associated with overall, disease-specific and disease-free survival.
INTERPRETATION
These results indicate that clinical T1 bladder cancer may be significantly understaged. Identifying factors associated with understaged and/or disease destined to progress (despite any prior intravesical or repeat transurethral therapies prior to radical cystectomy) will be critical to improve survival outcomes without over-treating clinical T1 disease that can be successfully managed with bladder preservation strategies.
背景
根治性膀胱切除术可能为临床T1期膀胱癌的治疗提供最佳生存结果。我们展示了来自一个大型、多机构、当代加拿大系列患者的数据，这些患者在单一支付者医疗保健系统中接受了根治性膀胱切除术治疗临床T1期膀胱癌。
方法
我们收集了一个汇总数据库，其中包括1993年至2008年期间在加拿大8个不同中心接受根治性膀胱切除术的2287例患者；这些患者中有306例患有临床T1期膀胱癌。使用Kaplan-Meier方法和Cox回归分析对生存数据进行分析。
结果
患者的中位年龄为67岁，平均随访时间为35个月。5年总生存率、疾病特异性生存率和无病生存率分别为71%、77%和59%。10年总生存率和疾病特异性生存率分别为60%和67%。病理分期分布为p0：32例（11%），pT1：78例（26%），pT2：55例（19%），pT3：60例（20%），pT4：27例（9%），pTa：16例（5%），pTis：28例（10%），pN0：215例（74%）和pN1 - 3：78例（26%）。仅12%的患者接受了辅助化疗。多因素分析显示，仅切缘状态和pN分期与总生存率、疾病特异性生存率和无病生存率独立相关。
解读
这些结果表明临床T1期膀胱癌可能存在显著的分期过低情况。识别与分期过低和/或注定进展的疾病相关的因素（尽管在根治性膀胱切除术之前进行了任何先前的膀胱内或重复经尿道治疗）对于改善生存结果至关重要，同时避免过度治疗可通过膀胱保留策略成功管理的临床T1期疾病。
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