Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
BJU Int. 2012 Nov;110(10):1471-7. doi: 10.1111/j.1464-410X.2012.11116.x. Epub 2012 Apr 4.
To determine whether a survival difference exists between patients with high grade (HG) cT1 urothelial cell carcinoma (UCC) receiving immediate radical cystectomy (IRC) as opposed to those choosing bladder-sparing therapy.
Between January 1990 and August 2010, 349 patients were retrospectively identified with a diagnosis of HG cT1 UCC of the bladder. Patients were divided into two groups: those who underwent IRC and those treated with conservative management (CM), consisting of transurethral resection of the bladder tumour (TURBT) and intravesical therapy. IRC was defined as surgery within 90 days of HG cT1 diagnosis with no intervening transurethral resection (TUR) or intravesical therapy (IVT). Trends in patient selection and cancer-specific survival (CSS) were analyzed over consecutive decades. The primary outcome was to compare CSS among patients during consecutive decades whereby management paradigms shifted from IRC to CM. The secondary outcome was to examine whether patient selection changed over time for each respective intervention.
One hundred and thirteen patients underwent IRC and 236 had CM. From 1990 to 1999, only 90 patients were diagnosed with HG cT1 disease, and a majority of patients (n= 54) underwent IRC. From 2000 to 2010, only 23% (59/259) of the patients with HG cT1 underwent IRC. Despite 42.3% more patients successfully maintaining their bladder in the long-term, no difference in 5 year bladder CSS was noted between decades (77% vs 80% consecutively, P= 0.566). A subset analysis of risk factors for bladder cancer progression/recurrence demonstrated more patients with lymphovascular invasion (LVI) on TUR underwent IRC in the current era (13/59 (22.0%) vs 13/200 (6.5%), P < 0.001). These findings remain to be validated in prospective work at other institutions.
Conservative management strategies are a viable treatment option within a well selected subset of patients with HG cT1 UCC.
确定患有高级别（HG）cT1 尿路上皮细胞癌（UCC）的患者在接受即刻根治性膀胱切除术（IRC）与选择保留膀胱治疗之间是否存在生存差异。
回顾性分析 1990 年 1 月至 2010 年 8 月期间被诊断为 HG cT1 膀胱癌的 349 例患者。患者分为两组：接受 IRC 治疗的患者和接受保守治疗（CM）的患者，CM 包括经尿道膀胱肿瘤切除术（TURBT）和膀胱内治疗。IRC 定义为在 HG cT1 诊断后 90 天内进行的手术，其间没有进行经尿道切除术（TUR）或膀胱内治疗（IVT）。分析了连续几十年患者选择和癌症特异性生存（CSS）的趋势。主要结局是比较连续几十年 IRC 治疗与 CM 治疗患者的 CSS，因为治疗模式从 IRC 转为 CM。次要结局是检查每个治疗方法的患者选择是否随时间而变化。
113 例患者接受 IRC 治疗，236 例患者接受 CM 治疗。1990 年至 1999 年，仅 90 例患者被诊断为 HG cT1 疾病，大多数患者（n=54）接受 IRC 治疗。2000 年至 2010 年，仅有 23%（59/259）的 HG cT1 患者接受 IRC。尽管长期来看，有 42.3%的患者成功保留了膀胱，但两个十年之间的 5 年膀胱 CSS 无差异（分别为 77%和 80%，P=0.566）。对膀胱癌进展/复发的危险因素进行亚组分析显示，当前时代接受 TUR 的具有脉管侵犯（LVI）的患者更多地接受 IRC（13/59（22.0%）比 13/200（6.5%），P<0.001）。这些发现有待在其他机构的前瞻性研究中进一步验证。
对于 HG cT1 UCC 的选择良好的患者亚组，保守治疗策略是一种可行的治疗选择。
