Zaghloul M S
Radiotherapy Department, National Cancer Institute, Cairo, Egypt.
Cancer. 1996 Feb 15;77(4):743-9. doi: 10.1002/(sici)1097-0142(19960215)77:4<743::aid-cncr21>3.0.co;2-#.
Distant metastasis is rarely described among bilharzial bladder cancer patients. However, with improved 5-year survival rates following adjuvant local therapy, distant metastasis is now reported with increasing frequency.
Three-hundred-fifty-seven bilharzial bladder cancer patients were treated at the National Cancer Institute in Cairo, Egypt, during the period 1981-1990. They were treated with either cystectomy alone, cystectomy preceded by a short course of preoperative radiotherapy (2000 cGy/5 fractions/1 week), or cystectomy followed by postoperative irradiation (5000 cGy/25 fractions/5 weeks or 3750 cGy/30 fractions/2 weeks). These patients were retrospectively analyzed.
The overall 5-year actuarial rate of distant metastasis was 23% (95% confidence interval, 21-25%), which was essentially the same in the 3 therapeutic groups. Both univariate and multivariate analyses revealed that the independent risk factors for distant metastasis were pelvic lymph node involvement (P = 0.005), pathologic stage (P = 0.004), and histopathologic grade (P = 0.05). Histologic type and local pelvic recurrence appeared in the univariate analysis as working risk factors; however, they were proven by multivariate analysis to be dependent on other risk factors. Patients who had none of the independent risk factors had a lower rate of distant metastasis (II%) and a high local control rate (88%). Those who had more than one risk factor had high distant metastasis rate (51%) and low local control rate (41%), regardless of the therapeutic modality used. The identified independent risk factors determined both the distant metastasis and the local control rates.
Unlike previous reports, this rigorous study of distant metastasis in bilharzial bladder cancer revealed an occurrence rate of 23%. This high rate was associated with pelvic lymph node involvement, pathologic stage, and histopathologic grade. Histologic type, local pelvic recurrence, or the addition of pre- or post-operative radiotherapy proved not to be independent risk factors.
在血吸虫性膀胱癌患者中，远处转移很少被描述。然而，随着辅助局部治疗后5年生存率的提高，现在远处转移的报告频率越来越高。
1981年至1990年期间，357例血吸虫性膀胱癌患者在埃及开罗国家癌症研究所接受治疗。他们接受了单纯膀胱切除术、术前短程放疗（2000 cGy/5次/1周）后行膀胱切除术，或膀胱切除术后放疗（5000 cGy/25次/5周或3750 cGy/30次/2周）。对这些患者进行了回顾性分析。
远处转移的总体5年精算率为23%（95%置信区间，21 - 25%），在3个治疗组中基本相同。单因素和多因素分析均显示，远处转移的独立危险因素为盆腔淋巴结受累（P = 0.005）、病理分期（P = 0.004）和组织病理学分级（P = 0.05）。组织学类型和局部盆腔复发在单因素分析中作为潜在危险因素出现；然而，多因素分析证明它们依赖于其他危险因素。没有任何独立危险因素的患者远处转移率较低（11%），局部控制率较高（88%）。有多个危险因素的患者远处转移率较高（51%），局部控制率较低（41%），无论采用何种治疗方式。确定的独立危险因素决定了远处转移率和局部控制率。
与以往报告不同，这项对血吸虫性膀胱癌远处转移的严谨研究显示发生率为23%。这一高发生率与盆腔淋巴结受累、病理分期和组织病理学分级有关。组织学类型、局部盆腔复发或术前或术后放疗的添加被证明不是独立危险因素。
