高级别T1期膀胱尿路上皮癌保留膀胱术后转归分析

摘要

背景与目的:对于经膀胱内治疗失败的高级别T1膀胱尿路上皮癌应积极采取膀胱全切术,但是部分患者由于某种原因接受了膀胱保留术式,其转归历程如何,到目前为止尚缺乏系统报道.本研究旨在分析高级别T1膀胱尿路上皮癌保留膀胱术后转归特点.方法:收集2005年1月-2006年2月首次在北京大学首钢医院行经尿道膀胱肿瘤切除或膀胱部分切除术的7例T1膀胱尿路上皮癌患者,术后膀胱肿瘤复发但未行膀胱全切术直至死亡全过程的临床资料.7例均采用入院诊治的方法随访.结果:7例T1膀胱癌患者均具有多发、高级别等高危因素,未行膀胱全切术原因分别是3例患者年龄过高(81、83和86岁)及4例严重心脏病.患者存活6～65个月(中位44.5个月),发生严重血尿7例、骨转移6例、肺转移5例、肝转移5例、肾上腺转移3例、胸壁转移1例,均死于膀胱癌相关事件.结论:高级别T1膀胱尿路上皮癌保留膀胱术后存活时间较短；易发生多处、远处转移,以骨、肺、肝最常见;血尿严重,无持续有效的治疗方法.%Background and purpose: Patients with high-grade T, urothelial carcinoma of bladder should undergo radical cystectomy when intravesical treatments failed. Nevertheless, some patients finally accepted bladder-sparing operations because of some reasons. Until now, no systemic and intact report about the progress and outcomes of these patients has occurred. So the aim of our research was to analyze the characteristics about the outcomes and progress of patients with high-grade T, urothelial carcinoma of bladder after bladder-sparing operation. Methods: Seven patients with high-grade T, urothelial carcinoma of bladder underwent transurethral resection of tumor or partial cystectomy from Jan. 2005 to Feb. 2006. The whole process and data of their postoperative follow-up and treatment were recorded by means of in-patient until to the end of their lives. Results: The high-risk characteristics of these patients with T, urothelial carcinoma of bladder were multi-focus and high-grade of cancer. They could not suffer radical cystectomy because of contraindications of severe cardiac disease for 4 patients and old age of 81 -86 years for 3 patients. They all died of bladder carcinoma-correlative disease and their cancer specific survival time was 6-65 months (median 44.5 months). Severe hematuria happened to 7 patients and metastasis to bone, lung, liver, adrenal and thoracic cavity wall did to 6, 5, 5, 3 and 1 patient, respectively. Conclusion: The cancer specific survival time is short for patients with high-grade Tt urothelial carcinoma of bladder after bladder-sparing operation. Metastasis to multiple far-distance organs occurred frequently, such as bone, lung and liver. There is no persistently effective therapy for severe hematuria.