中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2014年
7期
524-527
,共4页
吴涛%李刚%姜明东%王准%权昌益%牛远杰
吳濤%李剛%薑明東%王準%權昌益%牛遠傑
오도%리강%강명동%왕준%권창익%우원걸
膀胱%尿路上皮癌%鳞状分化%治疗%预后
膀胱%尿路上皮癌%鱗狀分化%治療%預後
방광%뇨로상피암%린상분화%치료%예후
Bladder%Urothelial carcinoma%Squamous differentiation%Treatment%Outcome
目的：探讨膀胱尿路上皮癌伴鳞状分化的临床病理特点及预后。方法回顾性分析2010年1月至2013年6月收治的48例膀胱尿路上皮癌伴鳞状分化患者（伴鳞状分化组）的临床资料，男39例，女9例。年龄29～87岁，中位年龄70岁。临床表现为无痛性肉眼血尿44例，体检发现膀胱占位4例。行TURBT 25例，膀胱部分切除术8例，根治性膀胱切除术13例，单纯双侧输尿管皮肤造瘘术1例，膀胱镜检1例。根据临床资料和手术方式按照1∶1匹配原则选取48例膀胱尿路上皮癌不伴鳞状分化的患者作为对照组，男40例，女8例。年龄39～86岁，中位年龄68岁。临床表现为无痛性肉眼血尿45例，体检发现膀胱占位3例。行TURBT 28例，膀胱部分切除术7例，根治性膀胱切除术13例。两组中53例行TURBT和1例行膀胱镜检者应用表柔吡星膀胱灌注治疗1年，其中19例行TURBT患者加用吉西他滨联合顺铂方案化疗3～6个周期。15例行膀胱部分切除术、26例行根治性膀胱切除术、1例行单纯双侧输尿管皮肤造瘘术患者应用吉西他滨联合顺铂方案化疗3～6个周期。结果两组96例患者术后病理诊断均为膀胱尿路上皮癌。伴鳞状分化组病理分期：pTa 期1例（2．1％），pT1期25例（52．1％），pT2期17例（35．4％），pT3期4例（8．3％）和pT4期1例（2．1％）。对照组：pTa 期1例（2．1％），pT1期28例（58．3％），pT2期16例（33．3％），pT3期2例（4．2％），pT4期1例（2．1％）。两组病理分级各有2例低级别和46例高级别。伴鳞状分化组术后平均随访16个月，复发8例，中位复发时间12个月；死亡3例，其中1例死于尿路上皮癌。对照组术后平均随访23个月，复发7例，中位复发时间22个月，无疾病进展和死亡病例。行TURBT的伴鳞状分化组3年复发率为49．5％，对照组为34．8％，差异有统计学意义（ P＜0．05）。结论膀胱尿路上皮癌伴鳞状分化的恶性程度高，复发率高，发生进展的风险高于单纯性膀胱尿路上皮癌，术后应密切随访。
目的：探討膀胱尿路上皮癌伴鱗狀分化的臨床病理特點及預後。方法迴顧性分析2010年1月至2013年6月收治的48例膀胱尿路上皮癌伴鱗狀分化患者（伴鱗狀分化組）的臨床資料，男39例，女9例。年齡29～87歲，中位年齡70歲。臨床錶現為無痛性肉眼血尿44例，體檢髮現膀胱佔位4例。行TURBT 25例，膀胱部分切除術8例，根治性膀胱切除術13例，單純雙側輸尿管皮膚造瘺術1例，膀胱鏡檢1例。根據臨床資料和手術方式按照1∶1匹配原則選取48例膀胱尿路上皮癌不伴鱗狀分化的患者作為對照組，男40例，女8例。年齡39～86歲，中位年齡68歲。臨床錶現為無痛性肉眼血尿45例，體檢髮現膀胱佔位3例。行TURBT 28例，膀胱部分切除術7例，根治性膀胱切除術13例。兩組中53例行TURBT和1例行膀胱鏡檢者應用錶柔吡星膀胱灌註治療1年，其中19例行TURBT患者加用吉西他濱聯閤順鉑方案化療3～6箇週期。15例行膀胱部分切除術、26例行根治性膀胱切除術、1例行單純雙側輸尿管皮膚造瘺術患者應用吉西他濱聯閤順鉑方案化療3～6箇週期。結果兩組96例患者術後病理診斷均為膀胱尿路上皮癌。伴鱗狀分化組病理分期：pTa 期1例（2．1％），pT1期25例（52．1％），pT2期17例（35．4％），pT3期4例（8．3％）和pT4期1例（2．1％）。對照組：pTa 期1例（2．1％），pT1期28例（58．3％），pT2期16例（33．3％），pT3期2例（4．2％），pT4期1例（2．1％）。兩組病理分級各有2例低級彆和46例高級彆。伴鱗狀分化組術後平均隨訪16箇月，複髮8例，中位複髮時間12箇月；死亡3例，其中1例死于尿路上皮癌。對照組術後平均隨訪23箇月，複髮7例，中位複髮時間22箇月，無疾病進展和死亡病例。行TURBT的伴鱗狀分化組3年複髮率為49．5％，對照組為34．8％，差異有統計學意義（ P＜0．05）。結論膀胱尿路上皮癌伴鱗狀分化的噁性程度高，複髮率高，髮生進展的風險高于單純性膀胱尿路上皮癌，術後應密切隨訪。
목적：탐토방광뇨로상피암반린상분화적림상병리특점급예후。방법회고성분석2010년1월지2013년6월수치적48례방광뇨로상피암반린상분화환자（반린상분화조）적림상자료，남39례，녀9례。년령29～87세，중위년령70세。림상표현위무통성육안혈뇨44례，체검발현방광점위4례。행TURBT 25례，방광부분절제술8례，근치성방광절제술13례，단순쌍측수뇨관피부조루술1례，방광경검1례。근거림상자료화수술방식안조1∶1필배원칙선취48례방광뇨로상피암불반린상분화적환자작위대조조，남40례，녀8례。년령39～86세，중위년령68세。림상표현위무통성육안혈뇨45례，체검발현방광점위3례。행TURBT 28례，방광부분절제술7례，근치성방광절제술13례。량조중53례행TURBT화1례행방광경검자응용표유필성방광관주치료1년，기중19례행TURBT환자가용길서타빈연합순박방안화료3～6개주기。15례행방광부분절제술、26례행근치성방광절제술、1례행단순쌍측수뇨관피부조루술환자응용길서타빈연합순박방안화료3～6개주기。결과량조96례환자술후병리진단균위방광뇨로상피암。반린상분화조병리분기：pTa 기1례（2．1％），pT1기25례（52．1％），pT2기17례（35．4％），pT3기4례（8．3％）화pT4기1례（2．1％）。대조조：pTa 기1례（2．1％），pT1기28례（58．3％），pT2기16례（33．3％），pT3기2례（4．2％），pT4기1례（2．1％）。량조병리분급각유2례저급별화46례고급별。반린상분화조술후평균수방16개월，복발8례，중위복발시간12개월；사망3례，기중1례사우뇨로상피암。대조조술후평균수방23개월，복발7례，중위복발시간22개월，무질병진전화사망병례。행TURBT적반린상분화조3년복발솔위49．5％，대조조위34．8％，차이유통계학의의（ P＜0．05）。결론방광뇨로상피암반린상분화적악성정도고，복발솔고，발생진전적풍험고우단순성방광뇨로상피암，술후응밀절수방。
Objective To investigate the clinical feature , pathologic characteristics and prognosis of urothelial carcinoma of bladder with squamous differentiation . Methods From Jan.2010 to Jun.2013, the pathological and clinical data of 96 cases of urothelial carcinoma of bladder with or without squamous dif-ferentiation were compared .Of the group with squamous differentiation , there were 39 males and 9 females with a median age of 70 (29 to 87) years.44 cases presented with painless gross hematuria .4 cases presen-ted with finding of bladder tumors in annual physical examination .TURBT, partial cystectomy and radical cystectomy were performed in 25, 8 and 13 cases, respectively.In addition, one case was only underwent bi-lateral ureteral skin gastrostomy .The last one only performed cystoscopy .In accordance with sex , age, path-ological stage and classification and surgical approach , 48 controls were selected .For the other group , there were 40 males and 8 females with a median age of 68 (39 to 86) years.45 cases presented with painless gross hematuria.3 cases presented with finding bladder tumors by annual physical examination .TURBT, par-tial cystectomy and radical cystectomy were performed in 28, 7 and 13 cases, respectively.All patients with retaining bladder had postoperative intravesical instillation for one year .Some patients with or without bladder performed 3-6 cycles chemotherapy with the GC protocol . Results In squamous differentiation group , there were 1 (2.1%) pTa, 25 (52.1%) pT1, 17 (35.4%) pT2, 4 (8.3%) pT3 and 1 (2.1%) pT4 tumors. Whereas, 1 (2.1%) pTa, 28 (58.3%) pT1, 16 (33.3%) pT2, 2 (4.2%) pT3 and 1 (2.1%)pT4 tumors were selected in the control group .There were 2 (4.2%) cases with low grade and 46 (95.8%) cases with high grade carcinomain in both groups .Patients were followed up with a mean duration of 16 and 12 months in squamous differentiation and control group , respectively .In squamous differentiation group , eight recur-rences were recorded with a mean follow-up of 12 months.Of the 3 died patients, only one died from bladder cancer.In control group, seven recurrences were recorded with a mean follow-up of 22 months, and no pa-tient died.For patients with TURBT, 3 year recurrence rate of patients with squamous differentiation was 49.5%, while the control was 34.8%.The difference was statistically significant (P<0.05). Conclusions Urothelial carcinoma of bladder with squamous differentiation is at a high level of malignant and recurrence . The rate of myometrial invasion with squamous differentiation is higher than pure urothelial bladder cancer . Patients with squamous differentiation should be closely followed up .
