Yang Guo-Liang, Zhang Lian-Hua, Liu Qiang, Wang Zhao-Liang, Duan Xue-Hui, Huang Yi-Ran, Bo Juan-Jie
Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Urol Oncol. 2017 Feb;35(2):38.e9-38.e15. doi: 10.1016/j.urolonc.2016.08.017. Epub 2016 Dec 28.
Management of high-grade T1 (formerly T1G3) bladder cancer continues to be controversial. Should patients with T1G3 bladder cancer have an immediate radical cystectomy or should they receive intravesical bacillus Calmette-Guérin-preserving bladder? Gemcitabine and cisplatin (GC) adjuvant chemotherapy may help to strike a balance between intravesical and early cystectomy. For purposes of this study, we continue to refer high-grade T1 lesion as "T1G3."
To evaluate the characteristics and the long-term outcome of GC adjuvant chemotherapy in T1G3 bladder cancer after transurethral resection of bladder tumor (TURBT).
We retrospectively reviewed 48 patients who were newly diagnosed with T1G3 bladder cancer between January 2009 and December 2012. A total of 48 patients received 4 cycles of GC adjuvant chemotherapy after TURBT. One month after 4 cycles of GC adjuvant chemotherapy, response was evaluated by re-TURBT. Median follow-up was 59.5 (range: 18-70) months, all patients have been observed for more than 3 years. Salvage cystectomy was recommended for patients with persistent disease and for tumor progression after initial complete response.
Complete response was achieved in 44 (91.7%) patients. Of complete responders, 5 patients experienced recurrence and 5 patients showed progression. The progression rate and disease-specific survival rate were 10.4% and 91.7% at 3 years, respectively. More than 80% of survivors preserved their bladder. Kaplan-Meier curves showed that concomitant carcinoma in situ (CIS) was the only factor that had an influence on progression-free survival (P = 0.022) and disease-specific survival (P = 0.017). Concomitant CIS was the prognostic factor for progression rate and disease-specific survival rate at 3 years (P = 0.008 and P = 0.035).
GC adjuvant chemotherapy is a safe conservative treatment for T1G3 bladder cancer, but effective is really a phase II study. Patients with T1G3 bladder cancer with concomitant CIS should be treated more aggressively because of the high risk of progression.
高级别T1（原T1G3）膀胱癌的治疗仍存在争议。T1G3膀胱癌患者应立即进行根治性膀胱切除术，还是应接受保留膀胱的卡介苗膀胱灌注治疗？吉西他滨和顺铂（GC）辅助化疗可能有助于在膀胱灌注和早期膀胱切除术之间取得平衡。在本研究中，我们继续将高级别T1病变称为“T1G3”。
评估经尿道膀胱肿瘤切除术（TURBT）后T1G3膀胱癌患者接受GC辅助化疗的特点和长期疗效。
我们回顾性分析了2009年1月至2012年12月期间新诊断为T1G3膀胱癌的48例患者。48例患者在TURBT后接受了4个周期的GC辅助化疗。在4个周期的GC辅助化疗1个月后，通过再次TURBT评估反应。中位随访时间为59.5（范围：18 - 70）个月，所有患者均已观察超过3年。对于疾病持续存在和初始完全缓解后肿瘤进展的患者，建议进行挽救性膀胱切除术。
44例（91.7%）患者达到完全缓解。在完全缓解者中，5例患者复发，5例患者出现进展。3年时的进展率和疾病特异性生存率分别为10.4%和91.7%。超过80%的幸存者保留了膀胱。Kaplan - Meier曲线显示，伴发原位癌（CIS）是唯一影响无进展生存期（P = 0.022）和疾病特异性生存期（P = 0.017）的因素。伴发CIS是3年时进展率和疾病特异性生存率的预后因素（P = 0.008和P = 0.035）。
GC辅助化疗是T1G3膀胱癌的一种安全的保守治疗方法，但有效性实际上是一项II期研究。由于进展风险高，伴发CIS的T1G3膀胱癌患者应接受更积极地治疗。
