Birkenhake S, Martus P, Kühn R, Schrott K M, Sauer R
Department of Radiooncology, University of Erlangen, Germany.
Strahlenther Onkol. 1998 Mar;174(3):121-7. doi: 10.1007/BF03038494.
Multivariate analysis of prognostic factors influencing survival and bladder preservation after radiochemotherapy for bladder cancer following transurethral resection of the bladder (TURB).
At the University Hospital of Erlangen 333 patients with bladder cancer were treated with either radiotherapy alone (RT, n = 128) or platin based radiochemotherapy (RCT, n = 205) after TURB between 5/1982 and 5/1996. Two-hundred and eighty-two curative patients, with either muscle invasive or T1-high risk cancer, were analyzed. Median age was 66 years, median follow-up is 7.5 years. Uni- and multivariate analysis was performed for age, grade, R-status after initial TURB, T-category and treatment modality relevant to the endpoints initial response, survival and bladder preservation.
Treatment related mortality was below 1%. Complete remissions were achieved at 57%, 70%, and 85% after RT or RCT with carboplatin or cisplatin. This difference was multivariately significant. Further significant prognostic factors were pT-category and R-status. For all patients survival was 59% and 43% after 5 and 10 years. 79% of survivors could keep their own bladder. Five-year survival rates after RT alone, RCT with carboplatin or cisplatin were 47%, 57%, and 69%, respectively. This was univariately significant. The only multivariately significant factor for survival and bladder preservation was the R-status after initial TURB.
Treatment of bladder cancer by TURB and RT/RCT is an alternative to primary cystectomy. The addition of chemotherapy leads to significantly more complete remissions and better survival. Initial TURB is recommended to be as radical as possible.
对经尿道膀胱肿瘤电切术（TURB）后膀胱癌患者接受放化疗后的生存及膀胱保留相关预后因素进行多因素分析。
在埃尔朗根大学医院，1982年5月至1996年5月期间，333例膀胱癌患者在TURB后接受了单纯放疗（RT，n = 128）或铂类为基础的放化疗（RCT，n = 205）。对282例患有肌层浸润性或T1高危癌的治愈性患者进行了分析。中位年龄为66岁，中位随访时间为7.5年。对年龄、分级、初次TURB后的R状态、T分期以及与初始反应、生存和膀胱保留终点相关的治疗方式进行单因素和多因素分析。
治疗相关死亡率低于1%。单纯放疗、含卡铂或顺铂的放化疗后的完全缓解率分别为57%、70%和85%。这种差异在多因素分析中具有显著性。其他显著的预后因素为pT分期和R状态。所有患者5年和10年生存率分别为59%和43%。79%的幸存者能够保留自身膀胱。单纯放疗、含卡铂或顺铂的放化疗后的5年生存率分别为47%、57%和69%。这在单因素分析中具有显著性。生存和膀胱保留的唯一多因素显著因素是初次TURB后的R状态。
TURB联合RT/RCT治疗膀胱癌是原发性膀胱切除术的一种替代方案。化疗的加入可显著提高完全缓解率并改善生存。建议初次TURB尽可能彻底。
