Dinney C P, Babkowski R C, Antelo M, Perrotte P, Liebert M, Zhang H Z, Palmer J, Veltri R W, Katz R L, Grossman H B
Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, USA.
J Urol. 1998 Oct;160(4):1285-90.
The selection of therapy for stage T1 bladder cancer is controversial, and reliable biomarkers that identify patients likely to require cystectomy for local disease control have not been established. We evaluated our experience with T1 bladder cancer to determine whether early cystectomy improves prognosis, and whether microvessel density has prognostic value for T1 lesions and could be used for patient selection.
We retrospectively reviewed the records of 88 patients with T1 transitional cell carcinoma of the bladder. Patient outcome was correlated with therapeutic intervention. Paraffin embedded tissue from 54 patients was available for factor VIII immunohistochemical staining for microvessel density quantification.
Median followup was 48 months (range 12 to 239). Of the patients 34% had no tumor recurrence. The rates of recurrence only and progression to higher stage disease were 41 and 25%, respectively. The survival of patients in whom disease progressed was diminished (p = 0.0002). Grade did not predict recurrence or progression nor did cystectomy provide a survival advantage. Microvessel density did not correlate with recurrence or progression.
Patients with T1 bladder cancer have a high risk of recurrence and progression. Tumor progression has a significant negative impact on survival. Neither grade nor early tumor recurrence predicted disease progression. Because early cystectomy did not improve patient outcome, we suggest reserving cystectomy for patients with progression or disease refractory to local therapy. Microvessel density is not a prognostic marker for T1 bladder cancer and has no value in selecting patients with T1 disease for cystectomy.
T1期膀胱癌的治疗选择存在争议，目前尚未确立能识别可能需要行膀胱切除术以控制局部疾病的可靠生物标志物。我们评估了我们治疗T1期膀胱癌的经验，以确定早期膀胱切除术是否能改善预后，以及微血管密度对T1期病变是否具有预后价值，能否用于患者的选择。
我们回顾性分析了88例T1期膀胱移行细胞癌患者的病历。将患者的预后与治疗干预相关联。54例患者的石蜡包埋组织可用于进行因子VIII免疫组化染色以定量微血管密度。
中位随访时间为48个月（范围12至239个月）。34%的患者无肿瘤复发。单纯复发率和进展至更高分期疾病的发生率分别为41%和25%。疾病进展患者的生存率降低（p = 0.0002）。分级不能预测复发或进展，膀胱切除术也未提供生存优势。微血管密度与复发或进展无关。
T1期膀胱癌患者有较高的复发和进展风险。肿瘤进展对生存有显著负面影响。分级和早期肿瘤复发均不能预测疾病进展。由于早期膀胱切除术未改善患者预后，我们建议将膀胱切除术保留用于疾病进展或对局部治疗难治的患者。微血管密度不是T1期膀胱癌的预后标志物，对选择T1期疾病患者进行膀胱切除术无价值。
