Department of Urology, Foch Hospital, 40 rue Worth, 92150 Suresnes, France.
World J Urol. 2012 Dec;30(6):821-6. doi: 10.1007/s00345-012-0936-8. Epub 2012 Sep 2.
To describe the epidemiology, clinical features, and prognostic factors of local recurrence (LR) in a large case series of patients treated by radical cystectomy (RC) for bladder cancer.
A retrospective study was conducted on 903 patients treated in a single tertiary reference center. All cases of LR were identified. Descriptive analysis was performed on the clinical features, evolution, and overall mortality of these patients. Prognostic factors of LR were assessed using the Mann-Whitney test for continuous variables and the χ(2) test for categorical variables.
Fifty-three patients were diagnosed with LR during follow-up (5.9 %). One patient had concomitant distant metastasis. Pain was the most frequent symptom leading to diagnosis. Mean time interval from RC to LR was 14.4 ± 13 months (1-64) with 50 % of cases diagnosed in the first postoperative year. Overall median survival of patients diagnosed with LR was 9 months [95 % confidence interval (6-11)]. Advanced pathological stage (T3 or T4) and lymph-node invasion were associated with increased LR rate in univariate and multivariate analysis. Presence of squamous cell carcinoma (SCC) was associated with a poorer prognosis after LR compared to pure urothelial carcinoma (p = 0.04). None of the parameters tested was associated with time interval between RC and LR diagnosis.
LR is not uncommon, favored by high pathological stage (T3/T4), and has a very bad prognosis, particularly when SCC is present. LR must be carefully tracked during follow-up after RC, and optimal management of these cases remains to be determined.
描述膀胱癌根治性膀胱切除术（RC）治疗的大病例系列患者中局部复发（LR）的流行病学、临床特征和预后因素。
对在单一三级参考中心接受治疗的 903 例患者进行了回顾性研究。确定了所有 LR 病例。对这些患者的临床特征、演变和总死亡率进行了描述性分析。使用 Mann-Whitney 检验对连续变量和 χ(2)检验对分类变量进行 LR 预后因素评估。
53 例患者在随访中被诊断为 LR（5.9%）。1 例患者同时伴有远处转移。疼痛是导致诊断的最常见症状。RC 至 LR 的平均时间间隔为 14.4 ± 13 个月（1-64），50%的病例在术后第一年被诊断。诊断为 LR 的患者的总体中位生存时间为 9 个月[95%置信区间（6-11）]。在单变量和多变量分析中，高级别病理分期（T3 或 T4）和淋巴结侵犯与 LR 发生率增加相关。与纯尿路上皮癌相比，LR 后存在鳞状细胞癌（SCC）与预后较差相关（p = 0.04）。在 RC 和 LR 诊断之间的时间间隔方面，测试的所有参数均无相关性。
LR 并不少见，倾向于高病理分期（T3/T4），且预后非常差，尤其是 SCC 存在时。在 RC 后随访期间必须仔细跟踪 LR，并确定这些病例的最佳治疗方法。
