Herr H W
Department of Surgery, Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, New York, New York.
J Urol. 1987 Nov;138(5):1162-3. doi: 10.1016/s0022-5347(17)43535-x.
Between May 1979 and July 1983, 217 consecutive patients with documented primary bladder tumors invading muscle were evaluated to determine the fate of patients with conservatively treated muscle-infiltrating bladder cancer. The disease was re-staged by urine cytology, bimanual examination with the patient under anesthesia and transurethral biopsy or resection. Of the 217 patients 172 underwent total or partial cystectomy and 45 (21 per cent, 37 with stage T2, 7 with stage T3a and 1 with stage T4 disease) did not because re-staging showed no residual tumor (stage T0) in 20, carcinoma in situ in 17, stage T1 tumor in 4 and local stage T2 cancer in 4. The median followup was 5.1 years (range 3 to 7 years). Of the 45 patients 30 (65 per cent) are free of tumor or have required transurethral resection and intravesical therapy for recurrent tumors but cystectomy has not been necessary. Of the 15 failures 11 underwent cystectomy 9 to 30 months after re-staging (7 are alive and 4 died of disease) and 4 are alive with metastatic disease (2 with negative bladder biopsies). Re-staging in the 4 patients who died showed stage T0 disease in 2, carcinoma in situ in 1 and stage T2 tumor in 1. The over-all survival rate was 82 per cent (37 of 45) and it was 67 per cent (30 of 45) for patients with a functioning bladder. The data suggest that endoscopic re-staging may identify a subset of patients with limited muscle-infiltrating bladder tumors that can be managed conservatively without immediate cystectomy.
在1979年5月至1983年7月期间，对217例经证实患有侵犯肌肉的原发性膀胱肿瘤的连续患者进行了评估，以确定接受保守治疗的肌肉浸润性膀胱癌患者的预后。通过尿液细胞学检查、在麻醉下对患者进行双手检查以及经尿道活检或切除术对疾病进行重新分期。在这217例患者中，172例行全膀胱或部分膀胱切除术，45例（21%，T2期37例，T3a期7例，T4期1例）未行膀胱切除术，原因是重新分期显示20例无残留肿瘤（T0期），17例原位癌，4例T1期肿瘤，4例局部T2期癌。中位随访时间为5.1年（范围3至7年）。在这45例患者中，30例（65%）无肿瘤或因复发性肿瘤需要经尿道切除和膀胱内治疗，但无需行膀胱切除术。在15例治疗失败的患者中，11例在重新分期后9至30个月行膀胱切除术（7例存活，4例死于疾病），4例有转移性疾病存活（2例膀胱活检阴性）。4例死亡患者的重新分期显示，2例为T0期疾病，1例为原位癌，1例为T2期肿瘤。总体生存率为82%（45例中的37例），有功能膀胱的患者生存率为67%（45例中的30例）。数据表明，内镜重新分期可能识别出一部分肌肉浸润性膀胱肿瘤局限的患者，这些患者可以保守治疗，无需立即行膀胱切除术。
