Pagano F, Bassi P, Ferrante G L, Piazza N, Abatangelo G, Pappagallo G L, Garbeglio A
Department of Urology, University of Padova, Italy.
J Urol. 1996 Jan;155(1):244-7.
A series of patients with concurrent transitional cell carcinoma involvement of the prostate and bladder is reviewed to define the impact of prostate involvement pathways and the degree of prostate invasion on survival rate.
A total of 72 patients who underwent radical cystectomy for pathological stage pT4a (D1) cancer was divided into contiguous--stage pT4a, transitional cell carcinoma of the bladder extended into the prostate through the bladder wall and noncontiguous--stage pT4a simultaneous transitional cell carcinoma of the prostate and bladder carcinoma that did not directly infiltrate into the prostate through the bladder wall. In the latter group the degree of prostate invasion was classified as urethral mucosal involvement, ductal/acinar involvement, stromal invasion and extracapsular extension. The survival rate was estimated by the Kaplan-Meier and Cox proportional hazards methods. Comparisons between curves were performed by univariate log rank and multivariate L-ratio tests.
The overall 5-year survival rate for stage pT4a was 21.5% (median followup 64 months). Furthermore, 46% and 7% of patients in noncontiguous and contiguous pT4a groups, respectively, were estimated to be alive (p < 0.000). Those with positive nodes experienced a poor outcome in both groups. Of patients with noncontiguous pT4a stage 100% with urethral mucosal involvement, 50% with ductal/acinar involvement and 40% with stromal invasion were estimated to be alive. The major prognostic factors were bladder tumor stage, nodal involvement and degree of prostate invasion.
The invasion pathways of the prostate in patients with transitional cell bladder carcinoma have a statistically significant prognostic role. Contiguous and noncontiguous involvements are 2 distinct clinicopathological features and they should not be included in the same stage. In the noncontiguous stage pT4a group bladder and prostate transitional cell carcinoma should be separately staged, and prostate involvement also should be staged according to invasion degree.
回顾一系列同时患有前列腺和膀胱移行细胞癌的患者，以确定前列腺受累途径及前列腺侵犯程度对生存率的影响。
对72例行根治性膀胱切除术的病理分期为pT4a（D1）癌患者进行分组，分为连续型——pT4a期，膀胱移行细胞癌经膀胱壁扩展至前列腺；非连续型——pT4a期，前列腺和膀胱癌同时存在，且未通过膀胱壁直接浸润至前列腺。在后一组中，前列腺侵犯程度分为尿道黏膜受累、导管/腺泡受累、间质侵犯和包膜外扩展。采用Kaplan-Meier法和Cox比例风险法估计生存率。通过单因素对数秩检验和多因素L-比值检验进行曲线比较。
pT4a期患者的总体5年生存率为21.5%（中位随访64个月）。此外，非连续型和连续型pT4a组分别有46%和7%的患者预计存活（p<0.000）。两组中出现阳性淋巴结的患者预后均较差。在非连续型pT4a期患者中，预计存活的患者比例为：尿道黏膜受累者100%，导管/腺泡受累者50%，间质侵犯者40%。主要预后因素为膀胱肿瘤分期、淋巴结受累情况和前列腺侵犯程度。
膀胱移行细胞癌患者中前列腺的侵犯途径具有统计学意义的预后作用。连续型和非连续型受累是两种不同的临床病理特征，不应纳入同一分期。在非连续型pT4a期组中，膀胱和前列腺移行细胞癌应分别分期，前列腺受累情况也应根据侵犯程度进行分期。
