肌肉浸润性膀胱癌的膀胱保留多模态治疗：五年随访

Bladder-sparing multimodality treatment of muscle-invasive bladder cancer: a five-year follow-up.

作者信息

Given R W, Parsons J T, McCarley D, Wajsman Z

机构信息

Department of Radiation Oncology, University of Florida College of Medicine, Gainesville 32610-0247, USA.

出版信息

Urology. 1995 Oct;46(4):499-504; discussion 504-5. doi: 10.1016/S0090-4295(99)80262-3.

DOI:10.1016/S0090-4295(99)80262-3

PMID:7571218

Abstract

OBJECTIVES

To determine the long-term results of a bladder-sparing approach in the treatment of muscle-invasive bladder cancer.

METHODS

Ninety-four patients with invasive transitional cell carcinoma of the bladder were treated by transurethral resection followed by 2 or 3 cycles of cisplatin-based chemotherapy. Patients were then treated with 6480 cGy of radiation in 49 patients, segmental cystectomy in 8, or surveillance only in 7. Patients who failed to respond to chemotherapy or radiation therapy, or who developed recurrent muscle-invasive disease in follow-up, underwent salvage cystectomy. Patients were then carefully followed for a median follow-up of more than 5 years.

RESULTS

After initial therapy, 53 patients (56%) were alive with their bladder preserved. Thirty of those 53 (57%) developed a local recurrence in follow-up. After a median follow-up of more than 5 years, the ultimate relapse-free survival is 49% (Stage T2, 84%; T3, 53%; and T4, 11%; P < 0.01). Of all patients enrolled, 53% had bladder preservation; however, of the currently surviving patients, 16 of 39 (41%) have their bladders intact (T2, 50%; T3, 37%; T4, 0%). Only 18% of the initially enrolled population is alive with a preserved bladder. The 5-year survival of patients who had cystectomy at some point during the study, compared with those who have had their bladders preserved, was 65% versus 40%, respectively (P < 0.01).

CONCLUSIONS

Our long-term results with multimodality therapy with attempted bladder preservation showed no definitive improvement in survival compared with modern series of cystectomy alone, and a disappointingly low rate of disease-free bladder preservation. We found a high rate of locally recurrent disease in the preserved bladders. We also noted a decrease in survival in our patients with bladder preservation compared with those without preservation. Bladder preservation, although possible, should be limited to a very select group of patients.

摘要

目的

确定保留膀胱治疗方法在肌层浸润性膀胱癌治疗中的长期效果。

方法

94例浸润性膀胱移行细胞癌患者接受经尿道切除术，随后进行2或3个周期的以顺铂为基础的化疗。之后，49例患者接受6480 cGy的放射治疗，8例接受节段性膀胱切除术，7例仅接受观察。对化疗或放疗无反应、或在随访中出现复发性肌层浸润性疾病的患者，接受挽救性膀胱切除术。然后对患者进行仔细随访，中位随访时间超过5年。

结果

初始治疗后，53例（56%）患者存活且膀胱得以保留。这53例患者中有30例（57%）在随访中出现局部复发。中位随访超过5年后，最终无复发生存率为49%（T2期，84%；T3期，53%；T4期，11%；P<0.01）。在所有入组患者中，53%的患者保留了膀胱；然而，在目前存活的患者中，39例中有16例（41%）膀胱完整（T2期，50%；T3期，37%；T4期，0%）。最初入组的患者中只有18%存活且膀胱得以保留。在研究期间接受过膀胱切除术的患者与保留膀胱的患者相比，5年生存率分别为65%和40%（P<0.01）。