Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, Los Angeles, CA, USA; Department of Urology, University of Bern, Bern, Switzerland.
BJU Int. 2014 Jan;113(1):65-9. doi: 10.1111/bju.12250. Epub 2013 Aug 13.
To evaluate oncological outcomes of patients with carcinoma in situ (CIS) exclusively at radical cystectomy (RC) and no previous history of ≥T1 disease.
Patients undergoing RC with curative intent for CIS between 1971 and 2008 at the University of Southern California were included if they met all the following criteria: (i) pathological CIS-only disease at RC, (ii) preoperative clinical stage cCIS and/or cCIS + cTa, and (iii) no previous history of lamina propria invasion (≥pT1). Kaplan-Meier plots were used to estimate the probabilities of recurrence-free survival (RFS) and overall survival (OS).
Of the 1964 consented patients 52 met the inclusion criteria with a median (range) follow-up of 8.5 (0.008-34) years. A median (range) of 36 (10-95) lymph nodes were identified per patient but no metastases found. Estimated 5- and 10-year RFS rates were 94% and 90%, respectively and estimated 5- and 10-year OS rates were 85% and 66%, respectively. Different mechanisms of recurrence were found in four (8%) patients after a median (range) interval of 2.4 (0.6-7.1) years. While two patients had metachronous recurrence within the urinary tract, the first of the other two had early systemic recurrence and the second late local recurrence.
We noticed excellent outcomes after RC for CIS-only disease. However, patients may have synchronous and/or develop metachronous tumours, as well as local and/or distant/systemic recurrence that can be cured but may also lead to fatal outcomes.
评估仅接受根治性膀胱切除术（RC）且无先前≥T1 疾病史的原位癌（CIS）患者的肿瘤学结果。
如果患者符合以下所有标准，则将其纳入 1971 年至 2008 年期间在美国南加州大学接受根治性 RC 治疗的 CIS 患者：（i）RC 时仅为病理 CIS 疾病，（ii）术前临床分期 cCIS 和/或 cCIS+ cTa，以及（iii）无先前固有层侵犯（≥pT1）病史。Kaplan-Meier 图用于估计无复发生存率（RFS）和总生存率（OS）。
在 1964 名同意参加的患者中，有 52 名符合纳入标准，中位（范围）随访时间为 8.5（0.008-34）年。每位患者的中位数（范围）为 36（10-95）个淋巴结，但未发现转移。估计 5 年和 10 年 RFS 率分别为 94%和 90%，估计 5 年和 10 年 OS 率分别为 85%和 66%。在中位（范围）间隔 2.4（0.6-7.1）年后，有 4 名（8%）患者发现不同的复发机制。虽然两名患者在尿路中出现了异时性复发，但其中两名患者发生了早期系统性复发，另一名患者发生了晚期局部复发。
我们注意到仅针对 CIS 疾病的 RC 后取得了良好的结果。然而，患者可能会出现同步和/或发生异时性肿瘤，以及局部和/或远处/系统性复发，这些复发虽然可以治愈，但也可能导致致命的结果。
