中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2012年
12期
911-917
,共7页
张敏光%沈周俊%张存明%吴瑜璇%周文龙%张荣明%祝宇%孙福康%邵远%黄欣
張敏光%瀋週俊%張存明%吳瑜璇%週文龍%張榮明%祝宇%孫福康%邵遠%黃訢
장민광%침주준%장존명%오유선%주문룡%장영명%축우%손복강%소원%황흔
膀胱尿路上皮癌%肌层浸润%膀胱部分切除术%保留膀胱%生存分析
膀胱尿路上皮癌%肌層浸潤%膀胱部分切除術%保留膀胱%生存分析
방광뇨로상피암%기층침윤%방광부분절제술%보류방광%생존분석
Bladder urothelial carcinoma%Muscle-invasive%Partial cystectomy%Bladdersparing therapy%Survival analysis
目的 探讨膀胱部分切除结合放化疗治疗肌层浸润性膀胱癌(MIBC)的安全性和疗效. 方法 收集2002-2007年MIBC病例136例.男108例,女28例.年龄30～ 88岁[(65.9±12.1)岁].按照手术方式分为膀胱部分切除术组(PC组)和根治性膀胱全切术组(RC组).PC组100例(T2 74例,T316例,T410例),T3、T4病例术后加行顺铂为主的放化疗；RC组36例(T212例,T320例,T44例).以电话和门诊方式随访,随访时间3 ～ 66个月[(33.1±1.2)个月].应用KaplanMeier法和log-rank检验比较2组生存情况,多因素Cox回归模型分析与MIBC生存和复发相关的预后因素. 结果 随访期间死于膀胱癌者40例,其中PC组24例(24％),RC组16例(44.4％)).总体5年肿瘤特异性生存率为65％,2组5年肿瘤特异性生存率分别为68％与55％ (P=0.033),总体肿瘤特异性生存期为49.9个月,2组分别为52.6和40.4个月.PC组术后出现非肌层浸润性膀胱癌复发46例(46％),肌层浸润性膀胱癌复发14例(14％)；其中术后16个月内局部复发45例(75％).PC组中,与肿瘤复发相关的独立因素包括肿瘤数量＞3个(RR=2.718),浸润性生长方式(RR =4.537)；与生存相关的独立因素包括肿瘤数量＞3个(RR=4.109),脉管侵袭(RR=6.098)和膀胱部分切除加输尿管再植术(PC+ UR) (RR=0.129),其中PC+ UR为保护因素；与MIBC生存相关的独立因素包括脉管侵袭(RR =4.176)、肿瘤数量＞3个(3.610)、高龄(＞70岁)(RR =2.609)、复发性膀胱癌(RR =2.714). 结论 PC结合放化疗是治疗MIBC的有效方法,可达到与RC相似甚至更高的生存率,肿瘤数量＞3个者不宜行保留膀胱手术.
目的 探討膀胱部分切除結閤放化療治療肌層浸潤性膀胱癌(MIBC)的安全性和療效. 方法 收集2002-2007年MIBC病例136例.男108例,女28例.年齡30～ 88歲[(65.9±12.1)歲].按照手術方式分為膀胱部分切除術組(PC組)和根治性膀胱全切術組(RC組).PC組100例(T2 74例,T316例,T410例),T3、T4病例術後加行順鉑為主的放化療；RC組36例(T212例,T320例,T44例).以電話和門診方式隨訪,隨訪時間3 ～ 66箇月[(33.1±1.2)箇月].應用KaplanMeier法和log-rank檢驗比較2組生存情況,多因素Cox迴歸模型分析與MIBC生存和複髮相關的預後因素. 結果 隨訪期間死于膀胱癌者40例,其中PC組24例(24％),RC組16例(44.4％)).總體5年腫瘤特異性生存率為65％,2組5年腫瘤特異性生存率分彆為68％與55％ (P=0.033),總體腫瘤特異性生存期為49.9箇月,2組分彆為52.6和40.4箇月.PC組術後齣現非肌層浸潤性膀胱癌複髮46例(46％),肌層浸潤性膀胱癌複髮14例(14％)；其中術後16箇月內跼部複髮45例(75％).PC組中,與腫瘤複髮相關的獨立因素包括腫瘤數量＞3箇(RR=2.718),浸潤性生長方式(RR =4.537)；與生存相關的獨立因素包括腫瘤數量＞3箇(RR=4.109),脈管侵襲(RR=6.098)和膀胱部分切除加輸尿管再植術(PC+ UR) (RR=0.129),其中PC+ UR為保護因素；與MIBC生存相關的獨立因素包括脈管侵襲(RR =4.176)、腫瘤數量＞3箇(3.610)、高齡(＞70歲)(RR =2.609)、複髮性膀胱癌(RR =2.714). 結論 PC結閤放化療是治療MIBC的有效方法,可達到與RC相似甚至更高的生存率,腫瘤數量＞3箇者不宜行保留膀胱手術.
목적 탐토방광부분절제결합방화료치료기층침윤성방광암(MIBC)적안전성화료효. 방법 수집2002-2007년MIBC병례136례.남108례,녀28례.년령30～ 88세[(65.9±12.1)세].안조수술방식분위방광부분절제술조(PC조)화근치성방광전절술조(RC조).PC조100례(T2 74례,T316례,T410례),T3、T4병례술후가행순박위주적방화료；RC조36례(T212례,T320례,T44례).이전화화문진방식수방,수방시간3 ～ 66개월[(33.1±1.2)개월].응용KaplanMeier법화log-rank검험비교2조생존정황,다인소Cox회귀모형분석여MIBC생존화복발상관적예후인소. 결과 수방기간사우방광암자40례,기중PC조24례(24％),RC조16례(44.4％)).총체5년종류특이성생존솔위65％,2조5년종류특이성생존솔분별위68％여55％ (P=0.033),총체종류특이성생존기위49.9개월,2조분별위52.6화40.4개월.PC조술후출현비기층침윤성방광암복발46례(46％),기층침윤성방광암복발14례(14％)；기중술후16개월내국부복발45례(75％).PC조중,여종류복발상관적독립인소포괄종류수량＞3개(RR=2.718),침윤성생장방식(RR =4.537)；여생존상관적독립인소포괄종류수량＞3개(RR=4.109),맥관침습(RR=6.098)화방광부분절제가수뇨관재식술(PC+ UR) (RR=0.129),기중PC+ UR위보호인소；여MIBC생존상관적독립인소포괄맥관침습(RR =4.176)、종류수량＞3개(3.610)、고령(＞70세)(RR =2.609)、복발성방광암(RR =2.714). 결론 PC결합방화료시치료MIBC적유효방법,가체도여RC상사심지경고적생존솔,종류수량＞3개자불의행보류방광수술.
Objective To review the experience with partial cystectomy combined with chemo-and radiation therapies in the treatment of muscle-invasive bladder cancer (MIBC) to assess the local control and survival rates,and to identify predictive factors for recurrence and survival.Methods From 2002 through 2007,a total of 100 patients with MIBC underwent partial cystectomy combined with adjuvant chemotherapy and radiation therapy (PC group).Meanwhile,36 patients with MIBC underwent radical cystectomy (RC group).The clinical and pathological data of these patients were retrospectively reviewed.Primary endpoints were cancer-specific survival (CSS),bladder-intact cancer-specific survival and bladder cancer recurrence.Results The 5-year CSS rate of the entire cohort was 65％,which was higher in PC group than in RC group (68％ vs 55％,P =0.033).In PC group,only 2 patients (2％) were confirmed to have residual tumor at the time of re-evaluation TUR 3 months after partial cystectomy.After a mean of 33.1 months,46 patients (46％) experienced superficial recurrence and 14 patients (14％) developed muscle-invasive recurrence.75％ of recurrence occurred within 16 months.8 patients underwent salvage cystectomy.The 5-year bladder-intact survival rate was 63％ in PC group.In multivariate analysis,the presence of tumor numbers more than 3 and tumors with infiltrating growth pattern were 2 predictive factors for cancer recurrence in PC group.In terms of survival,the presence of tumor numbers more than 3,lymphovascular invasion and partial cystectomy plus ureteral reimplantation (PC plus UR) were significantly associated with 5-y CSS in PC group and PC plus UR was indeed a protective factor for survival.By looking at the entire MIBC cohort,lymphovascular invasion,tumor numbers more than 3,history of superficial bladder cancer and age greater than 70 years old were identified as independent predictive factors for 5-y CSS.Conclusions Combined with adjuvant chemo-and radiation therapies,partial cystectomy might be a alternative to radical cystectomy for the treatment of MIBC,which provides adequate local control in selected patients,as well as acceptable survival rate.
