Marcelli G, Bottanelli A, Scattoni V, Baroni G P, Rovellini P, Sciaraffia G, Toia G
Divisione di Urologia, Ospedale di Rho, Azienda.
Arch Ital Urol Androl. 1996 Feb;68(1):67-9.
The treatment of T1 G3 bladder cancer is still an issue surrounded by much conflict. TUR of the bladder tumor as single treatment is considered not valid to be successful. TUR associated with intravescical chemotherapy or, even better, local immunotherapy may be the treatment of first choice in monocentric cancer, while radical cystectomy is, at the moment, the treatment of first choice in pluricentric or Cis associated T1 G3 bladder cancer. Since 1980, 25 patients with transitional T1 G3 bladder cancer have been observed in our department. Thirteen patients had a pluricentric disease while the remaining 12 cases had a monocentric bladder cancer. 92% of the patients (12/13) with a monocentric lesion and treated with TUR and local chemotherapy (Doxorubicin or BCG) are disease free after an average follow up of 34 Months (range 12-60 months). While 100% patients with a pluricentric cancer and treated with cystectomy are disease free after an average follow-up of 37 months (range 12-122 months); the 4 remaining cases with a pluricentric bladder lesion who refused cystectomy experienced a relapse of the disease after a follow-up of 19 months (range 9-27 months) and, despite surgery, they died within 12 months.
T1 G3期膀胱癌的治疗仍然是一个充满诸多争议的问题。单纯将膀胱肿瘤经尿道切除术（TUR）作为单一治疗方法被认为难以成功。TUR联合膀胱内化疗，或者更好的是联合局部免疫治疗，可能是单中心癌症的首选治疗方法，而目前根治性膀胱切除术是多中心或伴有Cis的T1 G3期膀胱癌的首选治疗方法。自1980年以来，我们科室共观察了25例移行性T1 G3期膀胱癌患者。其中13例为多中心疾病，其余12例为单中心膀胱癌。12例单中心病变患者接受了TUR和局部化疗（阿霉素或卡介苗），平均随访34个月（范围12 - 60个月）后，92%（12/13）的患者无疾病复发。而100%接受膀胱切除术的多中心癌症患者，平均随访37个月（范围12 - 122个月）后无疾病复发；其余4例拒绝膀胱切除术的多中心膀胱病变患者，随访19个月（范围9 - 27个月）后疾病复发，尽管接受了手术，但在12个月内死亡。
