Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Urol. 2012 Oct;188(4):1115-9. doi: 10.1016/j.juro.2012.06.029. Epub 2012 Aug 15.
To our knowledge long-term oncologic outcomes following partial cystectomy for urothelial carcinoma remain to be defined. We evaluated patterns of recurrence and survival among matched patients treated with partial vs radical cystectomy for bladder cancer.
We identified 86 patients who underwent partial cystectomy for pT1-4N0-1Mx urothelial carcinoma between 1980 and 2006 at our institution. They were matched 1:2 to patients undergoing radical cystectomy based on age, gender, pathological T stage and receipt of neoadjuvant chemotherapy. Survival was estimated using Kaplan-Meier analysis and compared with the log rank test.
Median postoperative followup was 6.2 years (range 0 to 27). No difference was noted for 10-year distant recurrence-free survival (61% vs 66%, p = 0.63) or cancer specific survival (58% vs 63%, p = 0.67) between patients treated with partial and radical cystectomy, respectively. Interestingly, 4 of 86 patients (5%) who underwent partial cystectomy showed extravesical pelvic tumor recurrence postoperatively vs 29 of 167 (17%) who underwent radical cystectomy (p = 0.004). In addition, 33 of 86 patients (38%) were diagnosed with intravesical recurrence of tumor after partial cystectomy and 16 of 86 (19%) initially treated with partial cystectomy ultimately underwent radical cystectomy.
Our matched analysis demonstrated no difference in metastasis-free or cancer specific survival between select patients undergoing partial cystectomy and those undergoing radical cystectomy. Nevertheless, patients treated with partial cystectomy remain at risk for intravesical recurrence and, thus, they should be counseled and surveilled accordingly.
据我们所知，部分膀胱切除术治疗尿路上皮癌的长期肿瘤学结果仍有待确定。我们评估了接受部分膀胱切除术与根治性膀胱切除术治疗膀胱癌的患者的复发和生存模式。
我们在本机构确定了 86 例 1980 年至 2006 年期间接受部分膀胱切除术治疗 pT1-4N0-1Mx 尿路上皮癌的患者。根据年龄、性别、病理 T 分期和新辅助化疗的接受情况，他们与接受根治性膀胱切除术的患者进行了 1:2 匹配。使用 Kaplan-Meier 分析估计生存情况，并通过对数秩检验进行比较。
中位术后随访时间为 6.2 年（范围 0 至 27 年）。接受部分膀胱切除术和根治性膀胱切除术的患者分别在 10 年远处无复发生存率（61% vs 66%，p = 0.63）和癌症特异性生存率（58% vs 63%，p = 0.67）方面无差异。有趣的是，86 例接受部分膀胱切除术的患者中有 4 例（5%）术后出现膀胱外盆腔肿瘤复发，而 167 例接受根治性膀胱切除术的患者中有 29 例（17%）（p = 0.004）。此外，86 例接受部分膀胱切除术的患者中有 33 例（38%）诊断为肿瘤膀胱内复发，86 例中有 16 例（19%）最初接受部分膀胱切除术的患者最终接受了根治性膀胱切除术。
我们的匹配分析表明，选择接受部分膀胱切除术和根治性膀胱切除术的患者之间在无转移或癌症特异性生存率方面没有差异。然而，接受部分膀胱切除术的患者仍有膀胱内复发的风险，因此应相应地对其进行咨询和监测。
