Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Int J Radiat Oncol Biol Phys. 2013 Mar 1;85(3):707-13. doi: 10.1016/j.ijrobp.2012.05.022. Epub 2012 Jul 3.
There is strong interest in partial-bladder radiation whether as a boost or definitive therapy to limit long-term toxicity. It is unclear that a standard preoperative examination can accurately identify all sites of disease within the bladder. The purpose of this study was to determine the correlation between preoperative localization of bladder tumors with postoperative findings to facilitate partial-bladder radiation techniques when appropriate.
We examined patients with clinically staged T1-T4 invasive transitional cell carcinoma (TCC) or TCC with variant histology with no history of radiation or partial cystectomy undergoing radical cystectomy. Patients were scored as "under-detected" if a bladder site was involved with invasive disease (≥T1) at the time of cystectomy, but not identified preoperatively. Patients were additionally scored as "widely under-detected" if they had postoperative lesions that were not identified preoperatively in a given site, nor in any adjacent site. Rates of under-detected and widely under-detected lesions, as well as univariate and multivariate association between clinical variables and under-detection, were evaluated using logistic regression.
Among 222 patients, 96% (213/222) had at least 1 area of discordance. Fifty-eight percent of patients were under-detected in at least 1 location, whereas 12% were widely under-detected. Among 24 patients with a single site of disease on preoperative evaluation, 21/24 (88%) had at least 1 under-detected lesion and 14/24 (58%) were widely under-detected. On multivariate analysis, only solitary site of preoperative disease was associated with increased levels of under-detection of invasive disease (OR = 4.161, 95% CI, 1.368-12.657).
Our study shows a stark discordance between preoperative and postoperative localization of bladder tumors. From a clinical perspective, incomplete localization of all sites of disease within the bladder may lead to marginal misses when a partial-bladder technique is used.
部分膀胱放疗无论是作为辅助治疗还是根治性治疗，都具有强烈的兴趣，以限制长期毒性。目前尚不清楚标准的术前检查是否能准确识别膀胱内所有病变部位。本研究的目的是确定术前膀胱肿瘤定位与术后发现之间的相关性，以便在适当情况下为部分膀胱放疗技术提供便利。
我们检查了接受根治性膀胱切除术的临床分期为 T1-T4 浸润性移行细胞癌（TCC）或 TCC 伴变异组织学且无放疗或部分膀胱切除术病史的患者。如果膀胱部位在膀胱切除时存在浸润性疾病（≥T1），但术前未发现，则患者被评为“未检出”。如果患者在特定部位或任何相邻部位均未发现术前未识别的术后病变，则患者被评为“广泛未检出”。使用逻辑回归评估未检出和广泛未检出病变的发生率，以及临床变量与未检出之间的单变量和多变量关联。
在 222 例患者中，96%（213/222）至少有 1 个部位存在差异。58%的患者至少有 1 个部位未检出，12%的患者广泛未检出。在术前评估仅有 1 个部位疾病的 24 例患者中，21/24（88%）至少有 1 个未检出病变，14/24（58%）广泛未检出。多变量分析显示，只有术前疾病的单一部位与侵袭性疾病未检出的发生率增加相关（OR=4.161，95%CI，1.368-12.657）。
我们的研究表明术前和术后膀胱肿瘤定位之间存在明显差异。从临床角度来看，当使用部分膀胱技术时，如果膀胱内所有病变部位的定位不完全，可能会导致部分病变漏诊。
