Holmäng S, Hedelin H, Anderström C, Holmberg E, Johansson S L
Oncology Center, Sahlgrenska University Hospital, Göteborg, Sweden.
J Urol. 1997 Mar;157(3):800-3; discussion 804. doi: 10.1016/s0022-5347(01)65044-4.
We studied the depth of invasion in the lamina propria in all patients with primary stage T1 bladder cancer in a geographical region and related the findings to the long-term prognosis.
All 121 primary stage T1 tumors diagnosed in western Sweden between 1987 and 1988 were analyzed with respect to the depth of invasion in relation to the lamina muscularis mucosae. All clinical records were reviewed in 1994 and 1995.
More than 90% of the histopathological specimens could be separated into superficially (pT1a) or deeply (pT1b) invasive stage T1 tumors. Grade 3 tumors were significantly more common among patients with stage pT1b disease (79 versus 40%, p < 0.001). Patients with stage pT1b grade 3 cancer had a higher progression rate (58 versus 36%, p > 0.05) and an almost doubled risk of dying of bladder carcinoma compared to those with stage pT1a grade 3 disease (45 versus 23%, p > 0.05). Carcinoma in situ at the primary operation was associated with an impaired prognosis in patients with grade 3 tumors regardless of the depth of invasion in the lamina propria.
The prognosis is poor in patients with deep lamina propria invasion (stage pT1b) treated with transurethral resection alone. Patients treated with radical cystectomy had excellent survival regardless of the depth of invasion in the lamina propria. Radiotherapy was associated with poor survival.
我们研究了某一地理区域内所有原发性T1期膀胱癌患者黏膜固有层的浸润深度，并将研究结果与长期预后相关联。
分析了1987年至1988年在瑞典西部诊断出的所有121例原发性T1期肿瘤，观察其相对于黏膜肌层的浸润深度。1994年和1995年对所有临床记录进行了回顾。
超过90%的组织病理学标本可分为浅表性（pT1a）或深部（pT1b）浸润性T1期肿瘤。pT1b期疾病患者中3级肿瘤明显更为常见（79%对40%，p<0.001）。与pT1a 3级疾病患者相比，pT1b 3级癌症患者的进展率更高（58%对36%，p>0.05），死于膀胱癌的风险几乎翻倍（45%对23%，p>0.05）。无论黏膜固有层的浸润深度如何，初次手术时的原位癌与3级肿瘤患者的预后受损相关。
单纯经尿道切除术治疗的黏膜固有层深度浸润（pT1b期）患者预后较差。接受根治性膀胱切除术治疗的患者，无论黏膜固有层的浸润深度如何，生存率都很高。放射治疗与生存率低相关。
