CAJ | 학술논문

目的比较根治性膀胱全切与保留膀胱手术治疗初发T1G3膀胱尿路上皮癌的临床效果.方法初发T1G3膀胱尿路上皮癌患者113例.男91例,女22例.年龄27～88岁,平均64岁.初次治疗保留膀胱患者81例,行根治性膀胱全切患者32例.采用Kaplan-Meier生存分析及log-rank检验比较2组患者5年总生存率及肿瘤特异性生存率.结果初次治疗保留膀胱患者81例中行经尿道肿瘤电切术74例、膀胱部分切除7例,术后随访6～140个月,平均64个月,术后5年总生存率为64.2%(52/81),肿瘤特异性生存率为77.8%(63/81).根治性膀胱全切治疗32例,术后随访4～141个月,平均62个月.术后5年总生存率为59.4%(19/32),肿瘤特异性生存率为75.0%(24/32).2组术后5年总生存率及肿瘤特异性生存率比较差异均无统计学意义(P>0.05).结论保留膀胱手术或根治性膀胱全切治疗初发T1G3膀胱癌,5年总生存率和肿瘤特异性生存率差异无统计学意义.膀胱全切治疗初发T1G3膀胱肿瘤至少有50%的病例有过度治疗的可能.
목적 비교근치성방광전절여보류방광수술치료초발T1G3방광뇨로상피암적림상효과.방법 초발T1G3방광뇨로상피암환자113례.남91례,녀22례.년령27～88세,평균64세.초차치료보류방광환자81례,행근치성방광전절환자32례.채용Kaplan-Meier생존분석급log-rank검험비교2조환자5년총생존솔급종류특이성생존솔.결과 초차치료보류방광환자81례중행경뇨도종류전절술74례、방광부분절제7례,술후수방6～140개월,평균64개월,술후5년총생존솔위64.2%(52/81),종류특이성생존솔위77.8%(63/81).근치성방광전절치료32례,술후수방4～141개월,평균62개월.술후5년총생존솔위59.4%(19/32),종류특이성생존솔위75.0%(24/32).2조술후5년총생존솔급종류특이성생존솔비교차이균무통계학의의(P>0.05).결론 보류방광수술혹근치성방광전절치료초발T1G3방광암,5년총생존솔화종류특이성생존솔차이무통계학의의.방광전절치료초발T1G3방광종류지소유50%적병례유과도치료적가능.
Objective To compare the long-term outcomes in patients with newly diagnosed stage T1G3 bladder cancer treated with bladder preserving approach and intravesical instillation or im-mediate cystectomy.Methods of 113 patients with a median age of 64 years (range 27 to 88) diag-nosed with T1G3 bladder cancer from January 1993 to February 2007,81 cases were treated by tran-sureteral resection with additional intravesieal instillation and 32 were treated with immediate cystecto-my.Differences between the 2 groups in 5-year overall survival and tumor specific survival were calcu-lated using the Kaplan-Meier survival function and analyzed by the log rank test.Results of 81 pa-tients treated with organ preserving approach and postoperative intravesical instillation,53 patients developed local recurrence and 21 patients underwent deferred cysteetomy in a median 64 (range 6-140) months follow-up.The overall and tumor specific survival at 5 years was 64.2% (52/81) and 77.8%(63/81),and in those who had deferred cystectomy it was 61.9% (13/21) and 76.2% (16/21),respectively.Of the 32 patients treated with immediate cystectomy,the 5-year overall and tumor specific survival was 59.4%(19/32) and 75.0%(24/32) within a median follow-up of 62(range 4-141)months.There was no statistical difference of the 5-year overall and tumor specific survival be-tween patients treated with bladder preserving approach or immediate cystectomy.Conclusion Blad-der preserving approach and immediate eystectomy might have similar 5-year overall and tumor specific survival for primary T1G3 bladder cancers.