Solsona E, Iborra I, Ricós J V, Monrós J L, Casanova J, Calabuig C
Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain.
J Urol. 1998 Jan;159(1):95-8; discussion 98-9. doi: 10.1016/s0022-5347(01)64022-9.
We analyzed the long-term results of radical transurethral resection for the treatment of a large series of patients with muscle infiltrating bladder cancer entered into a prospective study to determine progression predictive factors.
The study included 133 patients with invasive bladder cancer treated by radical transurethral resection who had negative biopsies of the muscle layer of the tumor bed. Followup was more than 5 years for all subjects and more than 10 years in 59 (44.4%). A comparative nonrandomized study was performed of a control group of 76 patients with invasive pathological stage pT2-3a, N0-3 bladder cancer treated by cystectomy. In those patients treated by radical transurethral resection univariate and multivariate analyses were performed to establish clinical progression predictive factors.
At 5 and 10 years of followup cause specific survival rates were 80.5 and 74.5%, and bladder preservation rates were 82.7 and 79.6%, respectively. No significant difference was noted in terms of cause specific survival, with respect to the control group. The initial presence of associated bladder carcinoma in situ was the only independent progression predictive factor.
For patients with invasive bladder cancer radical transurethral resection is justified when the tumor is clinically limited to the muscular layer and when all biopsies of the periphery and depth of the tumor bed show muscular tissue negative for tumor cells. Patients with initial associated bladder carcinoma in situ should not be excluded from this treatment but endovesical bacillus Calmette-Guerin immunotherapy should be administered and a closer followup is recommended.
我们分析了根治性经尿道切除术治疗大量肌肉浸润性膀胱癌患者的长期结果，这些患者进入了一项前瞻性研究以确定进展预测因素。
该研究纳入了133例接受根治性经尿道切除术治疗的浸润性膀胱癌患者，其肿瘤床肌肉层活检为阴性。所有受试者的随访时间超过5年，59例（44.4%）超过10年。对76例浸润性病理分期为pT2 - 3a、N0 - 3的膀胱癌患者行膀胱切除术作为对照组进行了一项非随机对照研究。对接受根治性经尿道切除术治疗的患者进行单因素和多因素分析以确定临床进展预测因素。
随访5年和10年时，病因特异性生存率分别为80.5%和74.5%，膀胱保留率分别为82.7%和79.6%。与对照组相比，病因特异性生存率无显著差异。初始合并膀胱原位癌是唯一独立的进展预测因素。
对于浸润性膀胱癌患者，当肿瘤临床局限于肌肉层且肿瘤床周边及深度的所有活检均显示肌肉组织无肿瘤细胞时，根治性经尿道切除术是合理的。初始合并膀胱原位癌的患者不应排除在该治疗之外，但应给予膀胱内卡介苗免疫治疗，并建议密切随访。
