Zincke H, Utz D C, Farrow G M
Urology. 1985 Oct;26(4 Suppl):39-46.
Experience with carcinoma in situ (CIS) of the urinary bladder during a twenty-year period at the Mayo Clinic is reviewed. The most important clinical clues for diagnosis of this disease continue to be irritative bladder symptoms in the absence of infection in elderly men and a history of transurethral resection of the prostate. The most reliable method of diagnosis is urinary cytology. When not modified by treatment, CIS is the precursor of most invasive cancers, originating probably from an area of atypical hyperplasia into CIS and, finally, into invasion. Among patients considered to have CIS who undergo cystectomy, 34 per cent may already have microinvasion. CIS has the potential to involve the entire urothelium. Prudence should guide the use of intravesical chemotherapy (mitomycin or thiotepa or doxorubicin), which may control the disease for extended periods in many patients. If primary treatment fails, immediate second-line treatment should include BCG or hematoporphyrin derivative (HpD) phototherapy or both. If such therapy fails, delay of radical cystectomy seems inadvisable. Monitoring of the prostatic urethra during intravesical treatment is mandatory; a radical surgical procedure should be performed once the prostatic urethra is involved. Results of treatment for secondary prostatic and upper urinary tract cancer are dismal. Conversely, secondary urethral disease, although it occurs frequently beyond five years, may be associated with a good prognosis.
本文回顾了梅奥诊所20年间膀胱原位癌（CIS）的诊疗经验。诊断该病最重要的临床线索仍是老年男性无感染情况下的膀胱刺激症状以及经尿道前列腺切除术史。最可靠的诊断方法是尿液细胞学检查。未经治疗时，CIS是大多数浸润性癌症的前驱病变，可能起源于非典型增生区域，先发展为CIS，最终发展为浸润。在接受膀胱切除术的CIS患者中，34%可能已发生微浸润。CIS有可能累及整个尿路上皮。使用膀胱内化疗（丝裂霉素、噻替派或阿霉素）时应谨慎，因为在许多患者中它可能长期控制病情。如果初始治疗失败，二线治疗应立即采用卡介苗（BCG）或血卟啉衍生物（HpD）光疗或两者联合。如果此类治疗失败，延迟行根治性膀胱切除术似乎不可取。膀胱内治疗期间必须监测前列腺尿道；一旦前列腺尿道受累，应行根治性手术。继发性前列腺癌和上尿路癌的治疗效果不佳。相反，继发性尿道疾病虽然常在五年后频繁发生，但预后可能良好。
