Ghoneim M A, el-Mekresh M M, el-Baz M A, el-Attar I A, Ashamallah A
Urology and Nephrology Center, Mansoura, Egypt.
J Urol. 1997 Aug;158(2):393-9.
We performed a critical analysis of the different prognostic factors affecting survival among patients with carcinoma of the bladder for whom cystectomy was indicated. The different patient and tumor characteristics were correlated to survival data by a univariate as well as multivariate analysis.
Between 1969 and 1990, 764 men and 262 women, average age plus or minus standard deviation 43 +/- 8 years, with invasive carcinoma of the bladder were eligible for 1-stage radical cystectomy and urinary diversion. Patients were followed regularly and examined signs for and location of treatment failure. Followup ranged from 0 to 24.2 years, with a median plus or minus standard deviation of 4.05 +/- 4.16 years.
Postoperative mortality was 4%. Most of the patients presented with advanced stage (greater than P3) disease. Squamous tumors accounted for 59% of cases, transitional carcinoma 22% and adenocarcinoma 11%. Bilharzial eggs were seen in 85% of the specimens. Regional lymph nodes were involved in 18.3% of the cases. The 5-year survival rate was 48%. The survival estimate was correlated to patient and tumor characteristics by univariate and multivariate analyses. Only tumor stage and grade, and lymph node status had a significant impact on survival.
Contemporary cystectomy with continent diversion for muscle invasive disease provides minimal morbidity, offers good locoregional disease control and results in acceptable quality of life. The presence of positive regional lymph nodes is not a contraindication to this therapy.
我们对影响需行膀胱切除术的膀胱癌患者生存的不同预后因素进行了批判性分析。通过单因素及多因素分析，将不同的患者和肿瘤特征与生存数据进行关联。
1969年至1990年间，764例男性和262例女性，平均年龄±标准差为43±8岁，患有浸润性膀胱癌，符合一期根治性膀胱切除术及尿流改道的条件。对患者进行定期随访，并检查治疗失败的体征和部位。随访时间为0至24.2年，中位时间±标准差为4.05±4.16年。
术后死亡率为4%。大多数患者表现为晚期（大于P3）疾病。鳞状肿瘤占病例的59%，移行癌占22%，腺癌占11%。85%的标本中可见血吸虫卵。18.3%的病例有区域淋巴结受累。5年生存率为48%。通过单因素和多因素分析，将生存估计值与患者和肿瘤特征进行关联。只有肿瘤分期和分级以及淋巴结状态对生存有显著影响。
对于肌肉浸润性疾病，采用可控性尿流改道的现代膀胱切除术并发症发生率低，能有效控制局部区域疾病，生活质量可接受。区域淋巴结阳性并非该治疗的禁忌证。
