Early versus deferred cystectomy for initial high-risk pT1G3 urothelial carcinoma of the bladder: Do risk factors define feasibility of bladder-sparing approach?
Early versus deferred cystectomy for initial high-risk pT1G3 urothelial carcinoma of the bladder: Do risk factors define feasibility of bladder-sparing approach?
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DOI：
10.1016/j.eururo.2007.06.030
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发表时间：
2008-01-01
期刊：
影响因子：
23.4
通讯作者：
Burger, Maximilian
中科院分区：
文献类型：
--
作者：
Denzinger, Stefan;Fritsche, Hans-Martin;Burger, Maximilian
目的：我们比较了初始pT1G3膀胱癌（BC）患者在初始保留膀胱方法后接受早期与延迟cycloxide（CX）治疗复发性pT1G3或肌肉浸润性BC的长期结局。本研究的目的是比较生存率和分析的影响，公认的危险因素多灶性，肿瘤大小，原位癌（CIS）在初始经尿道切除术的blader.Methods：在1995年和2005年之间，共有105例患者被诊断为初始pT1G3 BC具有>= 2个危险因素。45%的患者有多个肿瘤，73%的肿瘤大小>3 cm，46%的CIS。所有患者均接受了早期CX。51%的患者选择早期治疗，49%的患者因复发性BC而接受延迟CX。危险因素在各组之间均匀分布。结果：30%的病例中发现CX标本的分期升高。没有风险因素与分期上调有关。10年癌症特异性生存率在早期CX中为78%，在延迟CX中为51%（p < 0.01）。没有危险因素预测早期CX的癌症相关死亡。在生存分析中，CIS与延迟CX中较低的癌症特异性生存率相关（p < 0.001）。结论：与延迟CX相比，早期CX似乎延长了高危pT1G3 BC的癌症特异性生存率。CIS患者应考虑早期CX，因为延迟CX的情况下癌症特异性生存率降低。(c)2007年欧洲泌尿外科协会。Elsevier B.V.出版，保留所有权利。
Objectives: We compared long-term outcome in patients with initial pT1G3 bladder cancer (BC) treated with early versus deferred cystectomy (CX) for recurrent pT1G3 or muscle-invasive BC after an initial bladder-sparing approach. The aim of this study was to compare survival rates and to analyse the influence of the recognised risk factors multifocality, tumour size, and carcinoma in situ (CIS) in initial transurethral resection of the bladder.Methods: Between 1995 and 2005, a total of 105 patients were diagnosed with initial pT1G3 BC featuring >= 2 risk factors. Forty-five percent had multiple tumours, 73% tumours >3 cm in size, and 46% CIS. All patients were offered early CX. Fifty-one percent of patients opted for early and 49% underwent deferred CX for recurring BC. Risk factors were distributed evenly between the groups.Results: Upstaging in the CX specimen was found in 30% of cases. No risk factor was related to upstaging. The 10-yr cancer-specific survival rate was 78% in early CX and 51% in deferred CX (p < 0.01). No risk factor predicted cancer-related death in early CX. In survival analysis, CIS was related to a lower cancer-specific survival rate in deferred CX (p < 0.001).Conclusions: Early as opposed to deferred CX seems to prolong the cancer-specific survival rate in high-risk pT1G3 BC. Patients with CIS should be considered for early CX owing to reduced cancer-specific survival in case of deferred CX. (c) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.