Radical cystectomy for carcinoma of the bladder: 2,720 consecutive cases 5 years later
Radical cystectomy for carcinoma of the bladder: 2,720 consecutive cases 5 years later
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DOI：
10.1016/j.juro.2008.03.024
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发表时间：
2008-07-01
影响因子：
6.6
通讯作者：
El-Baz, Mahmoud A.
中科院分区：
文献类型：
--
作者：
Ghoneim, Mohamed A.;Abdel-Latif, Mohamed;El-Baz, Mahmoud A.
目的：我们对 1 个中心治疗浸润性膀胱癌的根治性膀胱切除术的结果进行了严格分析。材料和方法：1970 年至 2000 年间，2,090 名男性和 630 名女性浸润性膀胱癌患者接受了一期根治性膀胱切除术和尿流改道治疗。随访时间范围为 0 至 34.2 年，平均值为 5.5 +/- 5.7 年。使用单变量和多变量分析将生存数据与患者和肿瘤特征相关联。结果：术后死亡率为 2.6%。鳞状细胞瘤占49.4%，移行细胞癌占36.4%，腺癌占9.6%。 20.4%的病例累及区域淋巴结。 5年和10年无病生存率分别为55.5%和50.03%。有证据表明，肿瘤分期、组织学分级和淋巴结状态是影响生存概率的唯一自变量。结论：当代膀胱切除术可以以最低的死亡率进行。针对器官局限性疾病进行根治性膀胱切除术可以获得良好的治疗效果，并增加功能恢复的可能性。随着阶段进展，生存概率逐步降低。根治性手术可以为淋巴结阳性病例的一个重要亚组（27.3%）提供无病生存。需要额外的治疗来改善晚期局部区域疾病的肿瘤学结果。
Purpose: We performed a critical analysis of the results of radical cystectomy for invasive bladder carcinoma treated at 1 center.Materials and Methods: Between 1970 and 2000, 2,090 men and 630 women with invasive bladder cancer were treated with 1-stage radical cystectomy and urinary diversion. Followup ranged from 0 to 34.2 years with a mean of 5.5 +/- 5.7. Survival data were correlated to patient and tumor characteristics using univariate and multivariate analysis.Results: Postoperative mortality was 2.6%. Squamous tumors accounted for 49.4% of cases, transitional cell carcinoma for 36.4% and adenocarcinoma for 9.6%. Regional lymph nodes were involved in 20.4% of cases. The 5 and 10-year disease-free survival rates were 55.5% and 50.03%, respectively. Evidence was provided that tumor stage, histological grade and lymph node status are the only independent variables which affect survival probability.Conclusions: Contemporary cystectomy can be performed with minimal mortality. Radical cystectomy for organ confined disease is followed by good therapeutic results and enhances the possibilities for functional restoration. With stage progression there is a stepwise reduction in survival probability. The radical operation can provide disease-free survival for an important subgroup of node positive cases (27.3%). Additional therapy is needed to improve the oncological outcome for advanced locoregional disease.