Voskuilen Charlotte S, Seiler Roland, Rink Michael, Poyet Cédric, Noon Aidan P, Roghmann Florian, Necchi Andrea, Aziz Atiqullah, Lavollé Alexandre, Young Matthew J, Marks Phillip, Saba Karim, van Rhijn Bas W G, Fransen van de Putte Elisabeth E, Ablat Jason, Black Peter C, Sosnowski Roman, Dobruch Jakub, Kumar Pardeep, Jallad Samer, Catto James W F, Xylinas Evanguelos, Hendricksen Kees
Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Department of Urology, University Hospital Bern, Bern, Switzerland.
Eur Urol Focus. 2020 Nov 15;6(6):1226-1232. doi: 10.1016/j.euf.2018.12.002. Epub 2018 Dec 14.
Urothelial carcinoma arising in a bladder diverticulum (UCBD) is uncommon, and data on treatment and outcome are sparse.
To analyze clinicopathological characteristics of UCBD and to compare outcome after radical cystectomy (RC) and partial cystectomy (PC).
DESIGN, SETTING, AND PARTICIPANTS: Data of 115 UCBD patients treated with RC (n=81) or PC (n=34) between 2000 and 2016 were collected from 11 institutional databases and were analyzed retrospectively. Median follow-up was 5.0yr (95% confidence interval [CI]: 4.0-6.2).
Upstaging of tumor stage at diagnostic transurethral resection (TUR) to the RC/PC specimen was investigated. Overall survival (OS) and metastasis-free survival (MFS) after RC and PC were analyzed using Kaplan-Meier estimates, and compared using the log-rank test. Intravesical recurrences after PC were reported. A multivariable Cox proportional-hazard model was used to identify factors associated with OS.
There were no statistically significant differences in clinicopathological characteristics between RC and PC groups. Fifty-five percent of patients with cTa/is/1 at diagnostic TUR had ≥pT2 tumors at RC/PC. Five-year OS and MFS were, respectively, 62% and 66% for RC and 66% and 55% for PC (p=0.9 and p=0.6). Intravesical tumor recurrence was seen in six of 34 (18%) PC patients. In multivariable analysis, positive surgical margins and extravesical disease (≥pT2) were associated with worse OS, whereas treatment modality was not (RC: reference; PC: hazard ratio 0.94, [95% CI: 0.47-1.90], p=0.9).
Upstaging of UCBD was frequent, indicating an inaccuracy in clinical staging. We found no differences in OS or MFS between PC and RC groups; therefore, PC may represent a feasible surgical alternative to RC in selected UCBD patients.
In this report, we looked at the treatment of urothelial carcinoma arising in a bladder diverticulum (UCBD). We found that bladder-sparing treatment by partial cystectomy may be an alternative to radical cystectomy in carefully selected UCBD patients.
膀胱憩室内发生的尿路上皮癌（UCBD）并不常见，关于其治疗和预后的数据较少。
分析UCBD的临床病理特征，并比较根治性膀胱切除术（RC）和部分膀胱切除术（PC）后的预后。
设计、设置和参与者：从11个机构数据库中收集了2000年至2016年间接受RC（n = 81）或PC（n = 34）治疗的115例UCBD患者的数据，并进行回顾性分析。中位随访时间为5.0年（95%置信区间[CI]：4.0 - 6.2）。
研究诊断性经尿道切除术（TUR）时肿瘤分期在RC/PC标本中的上调情况。使用Kaplan-Meier估计法分析RC和PC后的总生存期（OS）和无转移生存期（MFS），并使用对数秩检验进行比较。报告PC后的膀胱内复发情况。使用多变量Cox比例风险模型确定与OS相关的因素。
RC组和PC组的临床病理特征在统计学上无显著差异。诊断性TUR时为cTa/is/1期的患者中，55%在RC/PC时肿瘤≥pT2期。RC组的5年OS和MFS分别为62%和66%，PC组分别为66%和55%（p = 0.9和p = 0.6）。34例PC患者中有6例（18%）出现膀胱内肿瘤复发。在多变量分析中，手术切缘阳性和膀胱外疾病（≥pT2）与较差的OS相关，而治疗方式无关（RC：参照；PC：风险比0.94，[95%CI：0.47 - 1.90]，p = 0.9）。
UCBD分期上调频繁，表明临床分期不准确。我们发现PC组和RC组在OS或MFS方面无差异；因此，在选定的UCBD患者中，PC可能是RC可行的手术替代方案。
在本报告中，我们研究了膀胱憩室内发生的尿路上皮癌（UCBD）的治疗。我们发现，在精心挑选的UCBD患者中，部分膀胱切除术的保膀胱治疗可能是根治性膀胱切除术的替代方案。
