Liaw Chuang-Chi, Chuang Cheng-Keng, Chang Ying-Hsu, Chang John Wen-Cheng, Liao Tzu-Yao, Juan Yu-Hsiang
Division of Hemato-Oncology, Department of Internal Medicine, Chang-Gung Memorial Hospital and Chang-Gung University College of Medicine, Taoyuan, Taiwan, R.O.C.
Department of Urology, Chang-Gung Memorial Hospital and Chang-Gung University College of Medicine, Taoyuan, Taiwan, R.O.C.
In Vivo. 2018 Jul-Aug;32(4):905-910. doi: 10.21873/invivo.11327.
BACKGROUND/AIM: Bladder cancer can spread from the sub-peritoneal space superior and posterolateral to the peritoneal cavity via the peritoneal lining. The aim of this study was to improve the identification of peritoneal spread from bladder urothelial carcinoma based on computed tomography (CT) scans.
This is a retrospective study including patients selected with the following criteria: (i) pathology-confirmed urothelial carcinoma; (ii) peritoneal spread identified on CT scans from axial and corona views, either initially or after radical/partial cystectomy, concomitant chemoradiotherapy (CCRT), or radiotherapy. One hundred and fifty-nine cases met the selection criteria.
Routes of spread to the peritoneum included the superior to anterior direction in 59 patients (37%), the superior to posterolateral direction in 19 (12%), and the superior to both anterior and posterolateral directions in 81 (51%). Invasion of specific sites included the abdominal wall in 101 patients (70%), bowel/mesentery in 84 (53%), prostate, uterus, and rectum in 30 (19%), and circumferential tumors that outlined the whole bladder wall in 59 (37%). Initial modes of therapy were chemotherapy in 86 patients (54%), cystectomy in 55 (35%), CCRT in eight (5%), radiotherapy in two (1%), and no therapy in eight (5%). Peritoneal spread due to under-staging (clinical/pathological stage) after local therapy was found in 84 patients (53%).
Initial pre-therapeutic staging is easily overlooked regarding peritoneal spread from bladder urothelial carcinoma. Combined axial and coronal views of CT scans can help identify peritoneal involvement.
背景/目的：膀胱癌可通过腹膜衬里从腹膜下间隙向上和后外侧扩散至腹膜腔。本研究的目的是基于计算机断层扫描（CT）改善膀胱尿路上皮癌腹膜转移的识别。
这是一项回顾性研究，纳入符合以下标准的患者：（i）病理确诊的尿路上皮癌；（ii）在CT扫描的轴位和冠状位视图上发现腹膜转移，无论是在初始时还是在根治性/部分膀胱切除术后、同步放化疗（CCRT）或放疗后发现。159例患者符合入选标准。
扩散至腹膜的途径包括向上至前方59例（37%）、向上至后外侧19例（12%）、向上至前方和后外侧81例（51%）。特定部位的侵犯包括腹壁101例（70%）、肠/肠系膜84例（53%）、前列腺、子宫和直肠30例（19%）、环绕整个膀胱壁的环形肿瘤59例（37%）。初始治疗方式为化疗86例（54%）、膀胱切除术55例（35%）、CCRT 8例（5%）、放疗2例（1%）、未治疗8例（5%）。84例（53%）患者在局部治疗后发现因分期不足（临床/病理分期）导致的腹膜转移。
对于膀胱尿路上皮癌的腹膜转移，初始治疗前分期容易被忽视。CT扫描的轴位和冠状位联合视图有助于识别腹膜受累情况。
