Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: A contemporary series from the bladder cancer research consortium
Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: A contemporary series from the bladder cancer research consortium
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DOI：
10.1016/j.juro.2006.08.004
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发表时间：
2006-12-01
影响因子：
6.6
通讯作者：
Lerner, Seth P.
中科院分区：
文献类型：
--
作者：
Shariat, Shahrokh F.;Karakiewicz, Pierre I.;Lerner, Seth P.
目的：我们介绍了针对膀胱移行细胞癌接受根治性膀胱切除术和盆腔淋巴结切除术治疗的大型、当代、连续系列患者的特征和结果。材料和方法：我们开发了一个多机构数据库，收集了 888 名连续接受根治性膀胱切除术和盆腔淋巴结切除术治疗的膀胱移行细胞癌患者的回顾性和前瞻性数据。 1984年至2003年间，在美国3个学术中心进行了根治性膀胱切除术和盆腔淋巴结切除术。结果：患者中25%的患者出现膀胱外肿瘤扩展且淋巴结阴性，23%出现淋巴结转移。淋巴结受累率随着病理分期的进展而增加。 5 年平均无复发生存率和膀胱癌特异性生存率 +/- SE 分别为 58% +/- 2% 和 66% ± 2%。术前多变量分析显示，临床肿瘤分期和新辅助全身化疗与癌症复发相关，而高龄、临床肿瘤分期和术前原位癌与膀胱癌特异性死亡率相关。术后多变量分析显示，肿瘤病理分期、淋巴结转移、淋巴血管侵犯、辅助放疗和辅助化疗与癌症复发相关，而较高的病理肿瘤分期、较高年龄、淋巴结转移、淋巴血管侵犯和辅助放疗与疾病特异性生存相关。转移至区域淋巴结的患者（pT 任何 N1-3）的膀胱癌复发和死亡风险显着高于膀胱外肿瘤扩展的患者（pT3N0），而后者的风险显着高于器官局限性疾病患者（pT2 N0 或更少）。 结论：这一大型、当代、多机构系列研究的结果表明，根治性膀胱切除术和 盆腔淋巴结切除术为局部浸润性移行细胞癌患者提供持久的局部控制和疾病特异性生存。
Purpose: We present the characteristics and outcomes of a large, contemporary, consecutive series of patients treated with radical cystectomy and pelvic lymphadenectomy for transitional cell carcinoma of the bladder.Materials and Methods: We developed a multi-institutional database and collected retrospective and prospective data on 888 consecutive patients with bladder transitional cell carcinoma who were treated with radical cystectomy and pelvic lymphadenectomy at 3 academic centers in the United States between 1984 and 2003.Results: Of the patients 25% had extravesical tumor extension with negative lymph nodes and 23% had lymph node metastasis. The rate of lymph node involvement increased with advancing pathological stage. Mean recurrence-free and bladder cancer specific survival +/- SE was 58% +/- 2% and 66% 2% at 5 years, respectively. On preoperative multivariate analysis clinical tumor stage and neoadjuvant systemic chemotherapy were associated with cancer recurrence, while more advanced age, clinical tumor stage and preoperative carcinoma in situ were associated with bladder cancer specific mortality. On postoperative multivariate analysis pathological tumor stage, lymph node metastasis, lymphovascular invasion, adjuvant radiotherapy and adjuvant chemotherapy were associated with cancer recurrence, while higher pathological tumor stage, more advanced age, lymph node metastasis, lymphovascular invasion and adjuvant radiotherapy were associated with disease specific survival. Patients with metastasis to regional lymph nodes (pT any N1-3) were at significantly higher risk for bladder cancer recurrence and death than patients with extravesical tumor extension (pT3N0), who in turn were at significantly higher risk than patients with organ confined disease (pT2 N0 or less).Conclusions: The results of this large, contemporary, multi-institutional series show that radical cystectomy and pelvic lymphadenectomy provide durable local control and disease specific survival in patients with localized invasive transitional cell carcinoma.