53例膀胱癌放射治疗的临床分析  

Radiotherapy of 53 patients with bladder cancer

作　　者：李云海[1] 冯炎[2] 王洪林[1] 

机构地区：[1]上海复旦大学附属上海市第五人民医院放射治疗科,上海200240 [2]上海复旦大学附属医院放射肿瘤科

出　　处：《实用肿瘤学杂志》2005年第2期116-119,共4页Practical Oncology Journal

摘　　要：目的总结膀胱癌放射治疗的疗效和毒副反应,评价和分析影响因素。方法对53例病理诊断为膀胱癌的患者进行回顾性分析,其中T2期22例,13期10例,T4期21例。9例有淋巴结转移;5例有远处转移。病理分类为:移形细胞癌40例,腺癌7例,鳞癌3例,移形细胞癌伴鳞癌3例。所有病人均接受了放射治疗,采用常规分割,照射剂量最低24.01Gy,最高69.94Gy,中位52.25Gy。局控及生存分析用Kapan-Meier法及Logrank检验。多因素分析采用Cox回归模型。结果中位随访期24个月,1、2、5年生存率分别为75.6%,51.1%和27.2%,1、2、5年局部失败率分别为14.8%,40.6%和56.2%。35例死亡,其中31例死于肿瘤,单因素分析显示只有不同分期的生存率有显著性差异,无肿瘤复发行放疗者较复发后放疗者局部失败低。多因素分析也表明T分期(T2期或T3+T4期)、N分期对于患者生存和局部控制均有统计学意义。结论对预后影响的关键是肿瘤的临床分期。全膀胱根治切除术后复发的治疗,如何提高局部控制是关键因素。需要随机研究来进一步探讨放射治疗在膀胱癌综合治疗的作用和地位。Objective To evaluate the outcomes and complications of the radiation therapy in bladder cancer, and analyze the prognosis factors. Methods We retrospectively analyzed 53 patients with bladder cancer. The clinical stages of the patients were T2:22;T3:10; and T4:21.9 patients were lymph node- positive, and 5 patients had distant, metastasis. The pathology of them were transitional cell carcinoma: 40; adenocarcinoma: 7; squamous cell carcinoma: 3; and transitional cell carcinoma plus squamous cell carcinoma: 3. All patients received conventional fractionation radiotherapy at a median dose of 52.25Gy, ranged 24.01-69.64 Gy. Kaplan-Meier method,Logrank method and Cox regression model were used in the statistic analysis. Results Median follow up was 24 months. The survival at 1 year, 3 years and 5 years was 75.6%, 51.1%, and 27.2% respectively. The rate of local failure was 14.8%, 40.6% , and 56.2% respectively. 35 patients died, and 31 patients died of tumor. In univariate analysis, only different stage (T2 vs T3 + T4, NO vs N1) was found as a prognosis factor in survival. The patients with tumor recurrence had a bad local control than the patients without recurrence. The same results showed in the multivariate analysis. Conclusion .The clinical stage was the pivotal influence factor of the prognosis.How to improve the local control was the most important problem to treat the patients with tumor recurrence after radical cystectomy. The large number of patients, multicenter,prospective randomized trial would be desirable to evaluate the outcome and status of radiotherapy in the multi - modality treatment of bladder cancer.

关 键 词：放射治疗 膀胱癌 临床分析 COX回归模型 多因素分析 局部控制 回顾性分析 病理诊断为 淋巴结转移 5年生存率 显著性差异 单因素分析 毒副反应 远处转移 病理分类 常规分割 照射剂量 生存分析 临床分期 预后影响 术后复发 

分 类 号：R737.14[医药卫生—肿瘤] R195.1[医药卫生—临床医学]