Harada Y, Seguchi T, Nonomura N, Kojima Y, Miki T, Okuyama A
Department of Urology, Osaka University Medical School.
Nihon Hinyokika Gakkai Zasshi. 1998 Aug;89(8):693-7. doi: 10.5980/jpnjurol1989.89.693.
To evaluate the natural history and the efficacy of treatments for carcinoma in situ (CIS) of the urinary bladder, we reviewed 70 patients with this disease.
The patients of CIS were divided into 3 groups based on tumor history: primary, secondary and concurrent CIS. We studied 70 patients with primary and secondary CIS treated at our hospital between 1957 and 1995, exclusive of concurrent one. They included 31 patients with primary CIS and 39 with secondary one, ranging in age from 39 to 82, with the average age of 63.1 years. Sixty-one patients were male and 9 were female.
In 31 patients with primary CIS, 12 (32.8%) complained of gross hematuria, 10 (32.3%) urinary frequency and 9 (29.0%) pain on urination. The 5-year survival rates for primary and secondary CIS were 89.1% and 91.4%, and the 5-year bladder preservation rates were 54.5% and 57.6%, respectively. Three of 31 patients with primary CIS developed an invasive carcinoma, whereas 4 of 39 patients with secondary CIS did. There was no significant difference between each primary and secondary groups. In both primary and secondary CIS, the group of immediate total cystectomy was not significantly differ from the groups of the following total cystectomy and the bladder preservation in the effect of total cystectomy on the survival rate. A total of 51 cases of CIS was treated with intravesical therapy, 17 intravesical Bacillus Calmette-Guérin (BCG) therapy, 34 intravesical chemotherapy, respectively. Intravesical BCG therapy has shown the complete response rate of 78.6%, intravesical chemotherapy 42.1%. And the bladder preservation rate seemed to be better (but not significantly) in intravesical BCG group than in intravesical chemotherapy group or non-treatment group of intravesical therapy.
For both primary and secondary CIS, the 5-year survival rate was about 90% and 5-year bladder preservation rate was over 50%. There was no significant difference between the primary and secondary group. The group of immediate total cystectomy was not significantly differ from the groups of the following total cystectomy and the bladder preservation in the effect of total cystectomy on the survival rate. About intravesical therapy, BCG was very effective in CR rate and the bladder preservation rate seemed to be better (but not significantly) in BCG group than in chemotherapy or non-treatment group.
为评估膀胱原位癌（CIS）的自然病史及治疗效果，我们回顾了70例患有该疾病的患者。
根据肿瘤病史将CIS患者分为3组：原发性、继发性和同时性CIS。我们研究了1957年至1995年在我院接受治疗的70例原发性和继发性CIS患者，不包括同时性CIS患者。其中包括31例原发性CIS患者和39例继发性CIS患者，年龄在39岁至82岁之间，平均年龄为63.1岁。61例为男性，9例为女性。
在31例原发性CIS患者中，12例（32.8%）主诉肉眼血尿，10例（32.3%）尿频，9例（29.0%）尿痛。原发性和继发性CIS的5年生存率分别为89.1%和91.4%，5年膀胱保留率分别为54.5%和57.6%。31例原发性CIS患者中有3例发展为浸润性癌，而39例继发性CIS患者中有4例发展为浸润性癌。原发性和继发性两组之间无显著差异。在原发性和继发性CIS中，即刻全膀胱切除术组在全膀胱切除术对生存率的影响方面与后续全膀胱切除术组和膀胱保留术组无显著差异。共有51例CIS患者接受了膀胱内治疗，其中17例接受膀胱内卡介苗（BCG）治疗，34例接受膀胱内化疗。膀胱内BCG治疗的完全缓解率为78.6%，膀胱内化疗为42.1%。膀胱内BCG组的膀胱保留率似乎比膀胱内化疗组或膀胱内治疗非治疗组更好（但无显著差异）。
对于原发性和继发性CIS，5年生存率约为90%，5年膀胱保留率超过50%。原发性和继发性组之间无显著差异。即刻全膀胱切除术组在全膀胱切除术对生存率的影响方面与后续全膀胱切除术组和膀胱保留术组无显著差异。关于膀胱内治疗，BCG在完全缓解率方面非常有效，且BCG组的膀胱保留率似乎比化疗组或非治疗组更好（但无显著差异）。
