Department of Urology, Hadassah University Medical Center, Jerusalem, Israel.
BMC Urol. 2013 May 8;13:23. doi: 10.1186/1471-2490-13-23.
The management of patients with high-grade non muscle invasive bladder cancer (NMIBC) brings diagnostic and therapeutic challenges. In the current study, we sought to study the natural history of progression to "secondary" muscle-invasive bladder cancer (MIBC)-cancer that developed during follow up of patients presenting with non-muscle invasive bladder cancer (NMIBC).
Between 1998 and 2008, 760 patients were treated for bladder cancer. Primary MIBC (>=T2) tumors (present upon presentation) were diagnosed in 114 patients. All patients with high-grade NMIBC were treated with intravesical BCG. Mean follow-up was 44 months.
Forty patients (6.1%) developed secondary MIBC after a mean period of 21 months from initial diagnosis of bladder cancer. The 2- and 5-year disease-specific survival rates were better for patients with secondary MIBC (90% and 56% compared to 69% and 42% for patients with primary disease, p=0.03). The Kaplan-Meier curves of the two groups were parallel but displaced by approximately 2 years.
In the current series, MIBC progression occurred among initially presenting patients with NMIBC in 6.1%. In most patients, the initial diagnosis of NMIBC is correct and muscle invasion occurs after a mean period of about 2 years. This supports a non-radical approach in patients with high-grade T1, Ta or Tis. Meticulous follow-up with liberal biopsy of any suspicious lesion may provide early diagnosis of invasive disease.
高级别非肌肉浸润性膀胱癌（NMIBC）的管理带来了诊断和治疗方面的挑战。在目前的研究中，我们试图研究进展为“继发性”肌层浸润性膀胱癌（MIBC）的自然史——即在非肌层浸润性膀胱癌（NMIBC）患者随访期间发展的癌症。
1998 年至 2008 年期间，760 例患者因膀胱癌接受治疗。114 例患者诊断为原发性 MIBC（>=T2）肿瘤（初诊时存在）。所有高级别 NMIBC 患者均接受膀胱内 BCG 治疗。平均随访时间为 44 个月。
40 例患者（6.1%）在最初诊断膀胱癌后平均 21 个月后发展为继发性 MIBC。继发性 MIBC 患者的 2 年和 5 年疾病特异性生存率更好（90%和 56%，与原发性疾病患者的 69%和 42%相比，p=0.03）。两组的 Kaplan-Meier 曲线平行，但相差约 2 年。
在目前的系列中，6.1%的初诊 NMIBC 患者出现 MIBC 进展。在大多数患者中，NMIBC 的初始诊断是正确的，并且在大约 2 年后发生肌肉侵犯。这支持在高级别 T1、Ta 或Tis 患者中采取非激进的方法。对任何可疑病变进行细致的随访并广泛进行活检可能有助于早期诊断侵袭性疾病。
