Department of Urology, Mayo Medical School and Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
World J Urol. 2012 Dec;30(6):795-9. doi: 10.1007/s00345-012-0855-8. Epub 2012 Mar 25.
Pathologic stage is a critically important prognostic factor after radical cystectomy (RC) that is used to guide the use of secondary therapies. However, the risk of disease recurrence, for patients clinically diagnosed with muscle-invasive tumors who are found not to have muscle-invasive disease at RC are poorly defined. Therefore, we reviewed the long-term outcomes in patients who were downstaged to non-invasive urothelial carcinoma at time of RC.
We identified 1,177 consecutive patients with muscle-invasive urothelial carcinoma of the bladder who underwent radical cystectomy at our institution between 1980 and 1999 without neoadjuvant therapy. Postoperative disease recurrence and survival were estimated using the Kaplan-Meier method and compared using the log rank test. Cox proportional hazard regression models were used to analyze the impact of pathologic stage on survival.
Pathologic downstaging to non-muscle invasive disease was identified in 538 (45.7 %) patients. The 10-year cancer-specific survival was 84.1, 77.4, 71.1 and 58.5 % for those with pT0, pTis, pT1 and pT2 tumors, respectively. On multivariate analysis, the risk of cancer-specific mortality was significantly decreased for patients with non-muscle invasive disease than those with organ-confined muscle invasion (RR-0.39; p = 0.002). There was no difference in disease-specific mortality among patients who had non-invasive (pT0, pTa, or pTis) disease (p = 0.19).
Downstaging from clinical muscle-invasive bladder cancer to non-muscle invasive disease at RC is associated with a significant reduction in cancer-specific mortality. However, even patients with residual non-muscle invasive disease may suffer disease recurrence and require continued surveillance after surgery.
病理分期是根治性膀胱切除术（RC）后一个极其重要的预后因素，用于指导辅助治疗的应用。然而，对于临床诊断为肌层浸润性肿瘤但在 RC 时发现没有肌层浸润性疾病的患者，疾病复发的风险定义不明确。因此，我们回顾了在 RC 时降期为非浸润性尿路上皮癌的患者的长期结果。
我们确定了 1980 年至 1999 年期间在我们机构接受根治性膀胱切除术且未接受新辅助治疗的 1177 例连续肌层浸润性膀胱癌患者。使用 Kaplan-Meier 方法估计术后疾病复发和生存情况，并使用对数秩检验进行比较。使用 Cox 比例风险回归模型分析病理分期对生存的影响。
538 例（45.7%）患者病理降期为非肌肉浸润性疾病。pT0、pTis、pT1 和 pT2 肿瘤患者的 10 年癌症特异性生存率分别为 84.1%、77.4%、71.1%和 58.5%。多变量分析显示，非肌肉浸润性疾病患者的癌症特异性死亡风险显著低于局限于器官的肌肉浸润性疾病患者（RR-0.39；p = 0.002）。非浸润性（pT0、pTa 或 pTis）疾病患者的疾病特异性死亡率无差异（p = 0.19）。
RC 时从临床肌层浸润性膀胱癌降期为非肌肉浸润性疾病与癌症特异性死亡率显著降低相关。然而，即使是残留的非肌肉浸润性疾病患者也可能发生疾病复发，需要在手术后继续进行监测。
