Ali-El-Dein Bedeir, Al-Marhoon Mohammed S, Abdel-Latif Mohamed, Mesbah Ahmed, Shaaban Atallah A, Nabeeh Adel, Ibrahiem El-Housseiny I
Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Urol Ann. 2011 Sep;3(3):127-32. doi: 10.4103/0974-7796.84960.
The optimal time of cystectomy for nonmuscle invasive bladder cancer (NMIBC) is controversial.
This study aims at comparing cancer-specific survival in primary versus deferred cystectomy for T1 bladder cancer.
Between 1990 and 2004, a retrospective cohort of 204 patients was studied.
Primary cystectomy at the diagnosis of NMIBC was performed in 134 patients (group 1) and deferred cystectomy was done after failed conservative treatment in 70 (group 2) Both groups were compared regarding patient and tumor characteristics and cancer-specific survival.
Cancer-specific survival was calculated using the Kaplan-Meier method.
Mean follow-up was 79 and 66 months, respectively, in the two groups. Tumor multiplicity was more frequent in group 2; otherwise, both groups were comparable in all characteristics. The definitive stage was T1 in all patients. Although the 3-year (84% in group 1 vs. 79% in group 2), 5-year (78% vs. 71%) and 10-year (69% vs. 64%) cancer-specific survival rates were lower in the deferred cystectomy group, the difference was not statistically significant. In group 2, survival was significantly lower in cases undergoing more than three transurethral resections of bladder tumors (TURBT) than in cases with fewer TURBTs.
Cancer-specific survival is statistically comparable for primary and deferred cystectomy in T1 bladder cancer, although there is a non-significant difference in favor of primary cystectomy. In the deferred cystectomy group, the number of TURBTs beyond three is associated with lower survival. Conservative treatment should be adopted for most cases in this category.
非肌层浸润性膀胱癌（NMIBC）膀胱切除术的最佳时机存在争议。
本研究旨在比较T1期膀胱癌一期膀胱切除术与延期膀胱切除术的癌症特异性生存率。
研究了1990年至2004年间的204例回顾性队列患者。
134例患者（第1组）在诊断为NMIBC时接受了一期膀胱切除术，70例患者（第2组）在保守治疗失败后接受了延期膀胱切除术。比较两组患者的特征、肿瘤特征及癌症特异性生存率。
采用Kaplan-Meier法计算癌症特异性生存率。
两组的平均随访时间分别为79个月和66个月。第2组肿瘤多发更常见；除此之外，两组在所有特征上具有可比性。所有患者的最终分期均为T1期。虽然延期膀胱切除术组的3年（第1组为84%，第2组为79%）、5年（78%对71%）和10年（69%对64%）癌症特异性生存率较低，但差异无统计学意义。在第2组中，接受超过三次经尿道膀胱肿瘤切除术（TURBT）的患者生存率明显低于接受TURBT次数较少的患者。
T1期膀胱癌一期膀胱切除术和延期膀胱切除术的癌症特异性生存率在统计学上具有可比性，尽管一期膀胱切除术有不显著的优势。在延期膀胱切除术组中，超过三次的TURBT次数与较低的生存率相关。此类大多数病例应采用保守治疗。
