Droller M J, Walsh P C
J Urol. 1985 Dec;134(6):1115-7. doi: 10.1016/s0022-5347(17)47650-6.
Recent enthusiasm for the use of intensive regimens of intravesical chemotherapy in the management of various forms of superficial transitional cell carcinoma of the bladder prompted us to examine retrospectively a group of patients with carcinoma in situ treated by such regimens who failed with progressive and metastatic cancer. Of 8 patients with flat carcinoma in situ treated with thiotepa 5 presented initially with concomitant solitary stage T1 papillary tumors that were resected successfully at initial presentation. Six patients had diffuse or multifocal carcinoma in situ, while 2 others had only a solitary focus of in situ disease. All patients had persistently positive urinary cytology studies during treatment, prompting 3 of them to receive intravesical mitomycin C following their course of thiotepa. Involvement of the prostatic urethra developed during therapy in 3 patients and 3 had muscle-infiltrative disease. At cystectomy 3 of 7 patients had positive pelvic lymph nodes and 4 died of distant metastases at an average of 8 months after cystectomy. These results suggest that despite the apparent advances that have been made in the control of recurrent superficial transitional cell bladder cancer, the intrinsic behavior of some forms of the disease may determine cancer progression. Identification of such patients is indicated for the institution of early aggressive treatment, which in the end may actually be the more conservative therapeutic approach.
近期，人们热衷于使用强化膀胱内化疗方案来治疗各种形式的浅表性膀胱移行细胞癌，这促使我们对一组接受此类方案治疗但最终出现癌症进展和转移而失败的原位癌患者进行回顾性研究。在8例接受噻替派治疗的扁平原位癌患者中，有5例最初伴有孤立性T1期乳头状肿瘤，这些肿瘤在初次就诊时被成功切除。6例患者患有弥漫性或多灶性原位癌，另外2例仅患有孤立性原位病灶。所有患者在治疗期间尿液细胞学检查持续呈阳性，促使其中3例在接受噻替派治疗后接受膀胱内丝裂霉素C治疗。3例患者在治疗期间出现前列腺尿道受累，3例患有肌肉浸润性疾病。在膀胱切除术中，7例患者中有3例盆腔淋巴结阳性，4例在膀胱切除术后平均8个月死于远处转移。这些结果表明，尽管在控制复发性浅表性膀胱移行细胞癌方面取得了明显进展，但某些形式疾病的内在行为可能决定癌症的进展。识别出这类患者后应尽早采取积极治疗，而这最终可能实际上是更保守的治疗方法。
