膀胱部分切除术结合放化疗在肌层浸润性膀胱癌治疗中的价值  

Value of partial cystectomy combined with chemotherapy and radiotherapy in the treatment of mus- cle-invasive bladder cancer

作　　者：张敏光[1] 沈周俊[1] 张存明[1] 吴瑜璇[1] 周文龙[1] 张荣明[1] 祝宇[1] 孙福康[1] 邵远[1] 黄欣[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院泌尿外科,200025

出　　处：《中华泌尿外科杂志》2012年第12期911-917,共7页Chinese Journal of Urology

摘　　要：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，T3 16例，T4 10例），T3、T4病例术后加行顺铂为主的放化疗；RC组36例（T2 12例，T3 20例，T4 4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Kaplan—Meier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。Objective To review the experience with partial eystectomy combined with ehemo- 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 endpo^nts 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-iovasive re- currence. 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 num- bers 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 th

关 键 词：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 

分 类 号：R737.14[医药卫生—肿瘤]