Academic Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
Ann Surg Oncol. 2011 Dec;18(13):3833-8. doi: 10.1245/s10434-011-1824-y. Epub 2011 Jun 7.
To assess the postsurgical survival of patients with urothelial carcinoma of the bladder with pT0 tumor at pathologic examination of cystectomy specimens.
A multi-institutional, retrospective database was analyzed with data from 4758 radical cystectomy (RC) patients who underwent RC without neoadjuvant chemotherapy and who were diagnosed with pT0 on the basis of the pathologic specimen. Survival curves were estimated. A multivariate Cox model was used to evaluate the association between prognosis factors and disease recurrence or survival.
Overall, 258 patients (5.4%) were included in the study. The median age was 64 years. At last resection, 171 tumors were invasive (at least pT2), and 87 were not. Median follow-up was 51 months. At multivariate analysis, initial location of the tumor and absence of lymphadenectomy were associated with tumor recurrence (P = 0.03 and P = 0.005, respectively) and specific mortality (P = 0.005 and 0.001, respectively). The main limitation of the study is its retrospective design, which is due to the rarity of this situation. Cancer-specific and recurrence-free survival rates were 89 and 85%, respectively, at 5 years and 82 and 80%, respectively, at 10 years.
Despite acceptable oncological outcomes, patients with a pT0 tumor at the time of RC are still at risk of recurrence and progression and should not be considered to be entirely cured. In this population, stringent follow-up according to current recommendations should be effective.
评估膀胱尿路上皮癌患者行根治性膀胱切除术（RC）时病理检查为 pT0 肿瘤的术后生存情况。
分析了来自 4758 例接受 RC 且未行新辅助化疗且病理标本诊断为 pT0 的 RC 患者的多机构回顾性数据库。估计生存曲线。使用多变量 Cox 模型评估预后因素与疾病复发或生存之间的关联。
共有 258 例患者（5.4%）纳入研究。中位年龄为 64 岁。在最后一次切除时，171 个肿瘤为浸润性（至少 pT2），87 个肿瘤不是。中位随访时间为 51 个月。多变量分析显示，肿瘤的初始位置和缺乏淋巴结切除术与肿瘤复发（P=0.03 和 P=0.005）和特定死亡率（P=0.005 和 P=0.001）相关。研究的主要局限性是其回顾性设计，这是由于这种情况罕见。5 年时癌症特异性和无复发生存率分别为 89%和 85%，10 年时分别为 82%和 80%。
尽管具有可接受的肿瘤学结果，但 RC 时为 pT0 肿瘤的患者仍有复发和进展的风险，不应被认为完全治愈。在该人群中，根据当前建议进行严格的随访应该是有效的。
