Altwein J E, Kurth K H, Hohenfellner R
Urologe A. 1977 May;16(3):180-2.
A therapeutic concept based on tumor staging and grading is presented: T0N0M0 - urine cytology positive - cystoscopy every 3 months. Transitional cell carcinoma (90%): T(iS)N0M0 - carcinoma in situ - cystoscopic biopsy every 3 months. Cystectomy with commencing tumor infiltration. T1N0M0 (80% of all bladder tumors): T1N0M0G0 - TUR; cystoscopy every 3 months. T1N0M0G1-3 - TUR; control-TUR 6 weeks later with systematic biopsy. G3 with tumor recurrence - cystectomy. T2N0/N1M0; G1-2 - TUR; local chemotherapy (adriamycin). G3 - cystectomy; high voltage treatment in inoperable patients. T4NxMx - symptomatic-palliative therapy: TUR, urinary diversion. Squamous cell carcinoma (2-5%): as transitional cell carcinoma; with high voltage therapy adjuvant chemotherapy using bleomycine. Adenocarcinoma (2-3%): as transitional cell carcinoma; cystectomy including part of the anterior abdominal wall and umbilicus. Immunostaging (assessment of the immunocompetence) should be part of the diagnostic procedures and follow-up examination.
T0N0M0 - 尿细胞学阳性 - 每3个月进行一次膀胱镜检查。移行细胞癌（90%）：T(iS)N0M0 - 原位癌 - 每3个月进行一次膀胱镜活检。肿瘤开始浸润时行膀胱切除术。T1N0M0（占所有膀胱肿瘤的80%）：T1N0M0G0 - 经尿道膀胱肿瘤切除术（TUR）；每3个月进行一次膀胱镜检查。T1N0M0G1 - 3 - TUR；6周后行对照TUR并进行系统活检。G3伴肿瘤复发 - 膀胱切除术。T2N0/N1M0；G1 - 2 - TUR；局部化疗（阿霉素）。G3 - 膀胱切除术；无法手术的患者行高压治疗。T4NxMx - 对症姑息治疗：TUR，尿流改道。鳞状细胞癌（2 - 5%）：同移行细胞癌；采用博来霉素进行高压治疗辅助化疗。腺癌（2 - 3%）：同移行细胞癌；膀胱切除术包括部分前腹壁和脐。免疫分期（免疫能力评估）应作为诊断程序和随访检查的一部分。
