Roggia A, Pozzi E, Malvestiti G M
Divisione di Urologia-Ospedale S. Antonio Abate, Gallarate.
Arch Ital Urol Androl. 1996 Feb;68(1):25-8.
The Bladder T.C.C. represents about 70% of urological malignancies. Superficial T.C.C. is generally treated with T.U.R. followed by endocavitary chemoprophylaxis (Mitomycin, Antraciclines etc.). Invasive tumors are cured by radical cystectomy and reconstructive lower urinary tract. T1G3 bladder cancer (involvement but no invasion of muscle layers) is a "border line" lesion and is not uniformely treated (some Authors choose a "conservative approach with T.U.R. and chemoprophylaxis, some others prefer an "aggressive" treatment with radical cystectomy and urinary diversion. Authors present their experience in the treatment of T1G3 (19 patients in 4 years with one year minimum follow-up) with a "conservative" approach (bladder T.U.R.) but "aggressive" post-operative treatement (immunotherapy with B.C.G. vaccine) and endoscopic reevaluation after ten weeks from the first observation. Prognostic factors are examined (number and dimension of the tumors, concomitant mild or severe dysplasia, positive or not citology) in order to extrapolate patients that will be at risk for develop an aggressive disease.
膀胱移行细胞癌约占泌尿系统恶性肿瘤的70%。浅表性移行细胞癌一般先进行经尿道膀胱肿瘤切除术(TUR),随后进行腔内化疗预防(丝裂霉素、蒽环类药物等)。浸润性肿瘤则通过根治性膀胱切除术和下尿路重建来治疗。T1G3膀胱癌(累及但未侵犯肌层)是一种“临界”病变,治疗方法并不统一(一些作者选择采用TUR和化疗预防的“保守方法”,另一些作者则倾向于采用根治性膀胱切除术和尿流改道的“积极”治疗方法)。作者介绍了他们采用“保守”方法(膀胱TUR)但“积极”术后治疗(卡介苗免疫治疗)并在首次观察后十周进行内镜重新评估治疗T1G3(4年中19例患者,至少随访一年)的经验。对预后因素进行了检查(肿瘤的数量和大小、是否伴有轻度或重度发育异常、细胞学检查是否阳性),以便推断哪些患者有发展为侵袭性疾病的风险。