膀胱部分切除术治疗盆腔淋巴结阴性的肌层浸润性膀胱癌100例生存分析

Survival analysis of 100 cases of partial cystectomy for pelvic lymph node-negative muscle invasivebladder cancer

目的报告膀胱部分切除术配合辅助化疗治疗盆腔淋巴结阴性的肌层浸润性膀胱癌的疗效，探讨肌层浸润性膀胱癌保留膀胱术后复发及生存的影响因素。方法回顾性分析2002年1月至2010年12月应用膀胱部分切除术配合辅助化疗治疗100例盆腔淋巴结阴性的肌层浸润性膀胱癌的临床疗效，COX回归分析探讨肌层浸润性膀胱癌保留膀胱术后复发及生存的影响因素。结果100例患者中无切缘阳性或切口种植病例。患者随访9～120个月，平均58个月。54例未复发，12例局部非肌层浸润性复发（其中4例为迟发型肌层浸润性复发），27例局部肌层浸润复发，3例局部肌层浸润复发伴盆腔淋巴结转移，2例局部肌层浸润性复发伴远处转移，2例仅有远处转移。10例因疾病复发接受膀胱全切，其中7例于膀胱切除术后9—47个月，平均22个月后死于膀胱癌；4例远处转移者接受姑息性化疗，但均在发现转移6个月内死于膀胱癌。23例局部肌层浸润复发患者接受了TURBT术和（或）化疗，其中2例死于其他原因，其余21例在复发后3～33个月，平均10个月后死于膀胱癌。5年总生存率（OS）、癌特异生存率（CSS）和无复发生存率（RFS）分别为58％、64％和50％。COX回归分析显示淋巴血管浸润、输尿管再植和有尿路上皮癌病史是OS、CSS和RFS的独立危险因素。结论膀胱部分切除配合辅助化疗选择性治疗淋巴结阴性的肌层浸润膀胱癌可以取得较为满意的疗效，但不适用于需要接受输尿管再植术及有尿路上皮癌病史者，而术后病理有淋巴血管侵犯往往提示预后较差。

Objective To report the effect of partial cystectomy （PC） plus chemotherapy in the treatment of pelvic lymph node-negative muscle invasive bladder eancer （MIBC） among selective patients and identify the predictive factors for survival and recurrence after PC. Methods One hundred cases of PC for MIBC （pT2-3 No M0 ） between 2002 and 2010 were retrospectively reviewed. Univariate and multivari- ate analyses were performed to determine the predictive factors for prognosis. Results The mean follow-up period was 58 months （range 9 to 120 months）. Of the 100 patients, 54 did not have tumor recurrence, 12 （ 12% ） had superficial recurrence in the bladder that was treated successfully and 4 of them had late recur- rence of muscle invasive disease, 34 had advanced recurrence of disease. Thirty-two patients died of bladder cancer and 50 patients survived with intaet bladder. The 5-year overall survival （ OS）, cancer-specific sur- vival （CSS） and recurrence free survival （RFS） were 58% , 64% and 50% , respectively. The multivari- able analysis showed that besides history of urothelial carcinoma （ H. UC） , lymphovascular invasion （LVI） and ureteral reimplantation （UR） were independent risk factors for OS, CSS and RFS. Conclusions H.UC and UR should be deemed as contraindications for PC and LVI predicts poor outcomes after PC. PC plus chemotherapy is effective management for MIBC with negative pelvic lymph node among selective patients.