Huguet J
Servicio de Urología, Hospital Clínic, Barcelona, España.
Actas Urol Esp. 2013 Jun;37(6):376-82. doi: 10.1016/j.acuro.2013.01.005. Epub 2013 Apr 21.
Following cystectomy, approximately 50% of patients will present tumour recurrence. A recurrence may be local, systemic or occur in the urethra or upper urinary tract.
To analyse the characteristics, risk factors and outcomes of patients with tumour recurrence following cystectomy so as to subsequently propose a cancer follow-up protocol.
Analysis of original articles and reviews related to tumour recurrence and follow-up after radical cystectomy for urothelial tumour. Articles were obtained from Pubmed searches.
Systemic and local recurrences following cystectomy appear in 20%-35% and 5%-15% of cases, respectively. Some 80%-90% are diagnosed in the first 3 years, with the majority concentrated in the first 24 months. Common factors related to an increased risk of local and systemic recurrence are a pathologic stage ≥pT3, the presence of positive margins and the extension of the lymphadenectomy. The incidence of recurrence in the upper urinary tract and urethra is 2%-6% and 4%-6%, respectively. Both types of recurrence may appear late and share risk factors such as signs of multifocal disease, a history of non-muscle-invasive bladder cancer, multiplicity, presence of ISC, urinary tract tumours and prostatic urethral tumours. Tumours in the distal ureteral cystectomy specimen and tumours in the prostatic urethra are also risk factors related to the appearance of tumours in the urinary tract and urethra, respectively.
Understanding the natural history of urothelial bladder carcinoma and the risk factors related to the appearance of tumour recurrence following cystectomy are essential for designing an appropriate follow-up protocol. The follow-up of patients with risk factors for local or systemic recurrence will achieve maximum efficiency during the first 3 years. The follow-up should be extended for patients with risk factors for presenting upper urinary tract or urethral tumours.
膀胱切除术后，约50%的患者会出现肿瘤复发。复发可能是局部、全身的，或发生于尿道或上尿路。
分析膀胱切除术后肿瘤复发患者的特征、危险因素及预后，以便随后提出癌症随访方案。
对与尿路上皮肿瘤根治性膀胱切除术后肿瘤复发及随访相关的原始文章和综述进行分析。文章通过PubMed检索获得。
膀胱切除术后全身和局部复发分别出现在20%-35%和5%-15%的病例中。约80%-90%在头3年被诊断出来，大多数集中在前24个月。与局部和全身复发风险增加相关的常见因素是病理分期≥pT3、切缘阳性以及淋巴结清扫范围。上尿路和尿道的复发率分别为2%-6%和4%-6%。两种类型的复发都可能出现较晚，且有共同的危险因素，如多灶性疾病迹象、非肌层浸润性膀胱癌病史、肿瘤多发、原位癌存在、尿路肿瘤和前列腺尿道肿瘤。输尿管膀胱切除标本远端的肿瘤和前列腺尿道的肿瘤也是分别与尿路和尿道肿瘤出现相关的危险因素。
了解尿路上皮膀胱癌的自然病史以及膀胱切除术后肿瘤复发出现的相关危险因素对于设计合适的随访方案至关重要。对有局部或全身复发危险因素的患者进行随访，在前3年将实现最大效率。对于有上尿路或尿道肿瘤危险因素的患者，随访应延长。
