Pham H T, Soloway M S
Department of Urology, University of Miami School of Medicine, FL 33101, USA.
Semin Urol Oncol. 1997 Aug;15(3):147-53.
The ideal treatment for T1 G3 transitional cell carcinoma (TCC) of the urinary bladder remains controversial. Therapeutic options after the initial transurethral (TUR) resection are observation, intravesical therapy, a repeat resection, radiation therapy, and cystectomy. Because more than half of patients with T1 G3 TCC of the urinary bladder do not progress, initial cystectomy can represent overtreatment. However, observation alone following TUR for T1 G3 TCC of the urinary bladder is associated with a progression rate of 48%. Intravesical immunotherapy has been shown to decrease recurrence and progression in high-grade Ta carcinoma in situ and T1 bladder cancer. When patients with T1 G3 tumors are well selected, intravesical therapy following the initial TUR can significantly improve survival and quality of life. Persistence or recurrence of high-grade tumor mandates consideration of cystectomy.
膀胱T1 G3移行细胞癌（TCC）的理想治疗方法仍存在争议。初次经尿道（TUR）切除术后的治疗选择包括观察、膀胱内灌注治疗、重复切除、放射治疗和膀胱切除术。由于超过一半的膀胱T1 G3 TCC患者病情不会进展，因此初次膀胱切除术可能属于过度治疗。然而，膀胱T1 G3 TCC经TUR后仅进行观察，其病情进展率为48%。膀胱内免疫治疗已被证明可降低高级别Ta原位癌和T1期膀胱癌的复发率及病情进展率。当精心挑选T1 G3肿瘤患者时，初次TUR后进行膀胱内灌注治疗可显著提高生存率和生活质量。高级别肿瘤持续存在或复发时，必须考虑行膀胱切除术。
