Radical cystectomy in patients with pathological non-muscle invasive bladder cancer

目的：分析非肌层浸润性膀胱癌行膀胱根治性切除的治疗效果，并总结此类患者的生存情况及其影响因素。方法：回顾2006年1月至2012年12月在北京大学第一医院行膀胱根治性切除的非肌层浸润性膀胱癌患者的病例资料，共164例，分析其术后总生存和疾病特异性生存、淋巴结转移情况、术后复发情况，以及影响其术后生存状况的相关因素。结果：所有入组的患者中159例为 T1期，5例为单纯原位癌（CIS），6例患者存在淋巴结转移（3．7％），中位随访时间46．5个月（7～99个月），有14例患者在随访过程中失访。有16例（9．8％）患者发生疾病复发，最常见的复发部位为肝转移，其次为骨转移和肺转移。本组患者的5年总生存率为85％，疾病特异性生存率为91％。行盆腔淋巴结清扫的患者在总生存（P ＝0．012）和疾病特异性生存（P ＝0．011）上均显著优于未清扫者，术后发生肿瘤复发者，总体预后较差，其总生存时间和疾病特异性生存时间均显著低于无复发者（P 均＜0．001），是否行盆腔淋巴结清扫是术后发生肿瘤复发的独立危险因素（P ＝0．050，OR ＝2．695，95％CI 0．999～7．271）。多因素 COX 回归分析显示，患者年龄（P ＝0．008，OR ＝1．071，95％CI 1．018～1．126）和是否进行淋巴结清扫（P ＝0．011，OR ＝3．385，95％CI 1．329～8．621）与疾病特异性生存相关。结论：对非肌层浸润性膀胱癌患者行早期膀胱根治性切除有较大的治疗意义，对于这类患者行盆腔淋巴结清扫有可能带来生存上的获益。Objective:Carcinoma of bladder is the most common malignancy in the urinary system in China.Most patients with this disease had non-muscle invasive bladder cancer (NMIBC)at the time of diagnosis.Radical cystectomy was indicated for patients with high risk or refractory NMIBC.We aimed to investigate the overall survival and disease-specific survival and related influence factors in patients un-dergoing radical cystectomy for pathological non-muscle invasive bladder cancer.Methods:From Jan. 2006 to Dec.2012,a total of 164 patients with pathological non-muscle invasive bladder cancer under-went radical cystectomy in Peking University First Hospital.Clinical data were retrospectively collected. Incidence of lymph node metastasis and disease recurrence were calculated.The risk factors of disease re-currence were analyzed.Kaplan-Meier plots were used to estimate the overall survival and cancer-specific survival.Multivariate Cox regression analysis was used to evaluate the prognostic factors for survival.Re-sults:Of all the patients included,159 had T1 disease,and 5 had CIS only.The median follow-up dura-tion was 46.5 months (range:7 -99 months).Fourteen patients were lost during the follow-up.Lymph node metastasis was noted in 6 patients (3.7%),4 patients had N1 disease,one patient had N2 di-sease,and one patient had N3 disease.Disease recurrence occurred in 16 patients (9.8%).The most common recurrence sites were the liver,bones,and lungs.The 5-year overall survival and disease-spe-cific survival for all the patients were 85% and 91%,respectively.The patients who underwent pelvic lymph node dissection showed a better prognosis in terms of disease-specific survival than those without (P =0.012).Patients with recurrence harbored a significant poorer survival (P <0.001).According to univariate Cox regression analysis,whether lymph node dissection was performed was an independent risk factor of disease recurrence (P =0.050,OR =2.695,95%CI 0.999 -7.271).In COX regression mo-del,age (P =0.008,OR =1.071,95%CI 1.018 -1.126)and whether lymph node dissection was performed (P =0.011,OR =3.385,95%CI 1.329 -8.621)were related to disease-specific survival. Conclusion:Patients with pathological non-muscle invasive bladder cancer underwent early radical cys-tectomy have a favorable prognosis,and bilateral pelvic lymph node dissection is essential for this proce-dure as it gains a survival benefit for the patients.PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)4627-6314