Department of Urology, St. Elisabeth Klinikum, Straubing LMU München, München, Germany.
BJU Int. 2011 Oct;108(8 Pt 2):E278-83. doi: 10.1111/j.1464-410X.2011.10189.x. Epub 2011 Jun 23.
•To evaluate the characteristics and long-term outcome of patients with pT0 stage after radical cystectomy (RC) for urothelial carcinoma of the urinary bladder (UCB).
•Clinical and pathological records of 2403 patients treated with RC for UCB were collected in a multi-institutional database. •The patients met the following criteria: clinical tumour stage cTa-cT2, cN0, cM0, no neoadjuvant chemotherapy or radiotherapy. •Overall (OS) and cancer-specific survival rates (CSS) were calculated for the various clinical tumour stages in relation to their corresponding pathological tumour stage in the RC sample. •Further to this, a multivariable prediction model was developed based on the available clinical data to estimate the probability of tumour stage pT0.
•The mean follow-up was 53 months and 132 patients (5.5%) were stage pT0. •Patients with stage cT2-pT0 had a 5-year CSS of 87% vs 69% for cT2-pT2 (P= 0.012) and 57% for cT2-pT+ (P < 0.001). •In a multivariable Cox-model, stage pT0 led to a significant reduction of cancer-specific mortality (hazard ratio0.27; 95% confidence interval 0.12-0.61). •A logistical regression model identified clinical tumour stage (advantage for non-invasive stages) and transurethral resection of the urinary bladder (TURB) time frame (advantage for more recent surgery) as independent predictors for stage pT0.
•In muscle-invasive clinical tumour stages, patients with pathological tumour stage pT0 form a subgroup showing a significantly better CSS. •A radical TURB is, assumedly, not causative of this improved survival rate, but rather it is that individual tumour characteristics allow for complete tumour eradication through the TURB procedure. •A TURB with R0 resection is, as such, only a sign of a better tumour prognosis.
评估接受根治性膀胱切除术（RC）治疗的膀胱癌（UCB）患者 pT0 期的特征和长期预后。
在一个多机构数据库中收集了 2403 例接受 RC 治疗 UCB 的患者的临床和病理记录。患者符合以下标准：临床肿瘤分期 cTa-cT2、cN0、cM0，无新辅助化疗或放疗。根据 RC 样本中的相应病理肿瘤分期，计算不同临床肿瘤分期的总生存率（OS）和癌症特异性生存率（CSS）。在此基础上，基于可用的临床数据开发了一个多变量预测模型，以估计肿瘤分期 pT0 的概率。
平均随访时间为 53 个月，132 例（5.5%）患者为 pT0 期。cT2-pT0 期患者的 5 年 CSS 为 87%，而 cT2-pT2 期为 69%（P=0.012），cT2-pT+期为 57%（P<0.001）。在多变量 Cox 模型中，pT0 期导致癌症特异性死亡率显著降低（风险比 0.27；95%置信区间 0.12-0.61）。逻辑回归模型确定临床肿瘤分期（非浸润性分期有利）和经尿道膀胱肿瘤切除术（TURB）时间框架（最近手术有利）是 pT0 期的独立预测因素。
在肌层浸润性临床肿瘤分期中，病理肿瘤分期为 pT0 的患者形成了一个 CSS 明显更好的亚组。假设，根治性 TURB 并不是导致这种生存率提高的原因，而是肿瘤的个体特征允许通过 TURB 手术完全根除肿瘤。因此，R0 切除的 TURB 只是肿瘤预后更好的一个迹象。
