van Gils-Gielen R J, Witjes W P, Caris C T, Debruyne F M, Witjes J A, Oosterhof G O
Department of Urology, University Hospital Nijmegen, The Netherlands.
Urology. 1995 Apr;45(4):581-6. doi: 10.1016/s0090-4295(99)80047-8.
In this article we describe the long-term follow-up of patients with carcinoma in situ (CIS) of the urinary bladder and examine whether the extent of CIS, the presence of associated papillary tumors, or the response to treatment influence the course of the disease.
Fifty-two patients with CIS of the bladder, treated in a randomized prospective study, are described. In 23 patients with concomitant papillary tumors all macroscopically visible lesions were completely resected transurethrally (TUR). CIS was histologically confirmed in all patients by biopsy, 29 of whom had primary CIS. The patients were treated with intravesical mitomycin, bacille Calmette-Guérin (BCG)-RIVM or BCG-Tice and followed regularly by urine cytology, cystoscopy, and biopsy.
Complete response was achieved in 65% of the patients. Of these responders, 24% later had a recurrence of CIS or a superficial tumor and 18% had progressive disease (PD). In the nonresponding patients, progression occurred in 67%. In the whole group, PD was seen in 35% of the patients, and radical cystectomy was performed in 21%. The disease-related death rate was 13%. The risk for recurrence or PD was not higher in patients with more extensive CIS, defined as three or more positive biopsy results or when CIS was associated with papillary tumors compared to patients with one or two biopsy specimens positive for CIS or CIS alone. Nonresponding patients showed a significantly higher progression rate and cystectomy rate than responding patients (P = 0.0012 and 0.008, respectively).
CIS of the bladder is a malignancy with a poor prognosis, especially in patients not responding after intravesical treatment. Early detection and adjuvant intravesical treatment after TUR of concomitant papillary tumors are required. In patients not responding after intravesical treatment, radical surgery is necessary before progression occurs. The number of biopsies positive for CIS, not the presence of concomitant superficial tumors, was an indicator for progression or recurrence.
在本文中，我们描述了膀胱原位癌（CIS）患者的长期随访情况，并研究CIS的范围、相关乳头状肿瘤的存在或治疗反应是否会影响疾病进程。
描述了52例在一项随机前瞻性研究中接受治疗的膀胱CIS患者。在23例伴有乳头状肿瘤的患者中，所有肉眼可见的病变均经尿道完全切除（经尿道切除术）。所有患者均通过活检在组织学上确诊为CIS，其中29例为原发性CIS。患者接受膀胱内丝裂霉素、卡介苗（BCG）-RIVM或BCG-Tice治疗，并定期进行尿液细胞学检查、膀胱镜检查和活检。
65%的患者实现了完全缓解。在这些缓解者中，24%后来出现了CIS复发或浅表肿瘤，18%出现了疾病进展（PD）。在未缓解的患者中，67%出现了疾病进展。在整个组中，35%的患者出现了PD，21%的患者接受了根治性膀胱切除术。疾病相关死亡率为13%。与CIS活检结果为一或两个阳性或单纯CIS的患者相比，CIS范围更广（定义为三个或更多活检结果阳性）或CIS与乳头状肿瘤相关的患者，其复发或PD风险并不更高。未缓解的患者显示出比缓解患者显著更高的疾病进展率和膀胱切除率（分别为P = 0.0012和0.008）。
膀胱CIS是一种预后不良的恶性肿瘤，尤其是在膀胱内治疗后无反应的患者中。需要早期检测并在切除伴随的乳头状肿瘤后进行辅助膀胱内治疗。在膀胱内治疗无反应的患者中，在疾病进展之前进行根治性手术是必要的。CIS活检阳性的数量，而非伴随浅表肿瘤的存在，是疾病进展或复发的一个指标。
