13例膀胱小细胞癌的诊疗体会并文献复习

Study the Diagnosis and Treatment of Small Cell Carcinoma of the Urinary Bladder:a Clinical Analysis of 13 Cases

目的通过分析临床病例诊疗数据及文献回顾,探讨膀胱小细胞癌治疗方案的选择。方法回顾性分析山东大学附属省立医院自1997年至2016年间收治的13例膀胱小细胞癌(small cell carcinoma of the urinary bladder,SCCB)患者临床资料,包括患病年龄、首发症状、疾病分期及治疗方式,采用Kaplan-Meier法统计患者1年、3年及5年生存率。结果 13位患者平均年龄(71±10.12)岁。血尿为首发症状占92.31%。Ⅰ期(T_1N_0M_0)1例,Ⅱ期(T_2N_0M_0)5例,Ⅲ期(T_3N_0M_0,T_(4a)N_0M_0)3例,Ⅳ期(T_(4b)N_xM_x)4例。共随访12例患者,1例失访。患者1年总生存率为66.67%,3年总生存率33.33%,5年总生存率33.33%。保留膀胱手术联合PE(依托泊苷+铂类)化疗者,1年的生存率88.89%,3年的生存率44.44%,5年的生存率44.44%。结论 SCCB作为一种罕见的高侵袭性恶性肿瘤,预后普遍较差。综合文献及本研究,对于局限无进展期疾病,根治性膀胱手术加PE化疗治疗效果较好,新辅助化疗联合手术似乎更具优势,对于高龄、不能耐受根治性手术、及保留膀胱意愿强烈的患者可采取保留膀胱的手术联合全身PE化疗,但需要注意随访。

Objective To discuss the treatment strategy of the small cell carcinoma of the bladder （SCCB） by analyzing of the clinical feature, tumor character, treatment process and prognosis. Methods A retrospective analysis of the clinical feature, tumor character, treatment process and prognosis of patients with pathologically confirmed SCCB. With SPSS Statistics V19.0, Kaplan - Meier survival curves were plotted for the group. Results The mean age was 71 ± 10.12 years. Of all cases, 92.31% presented with hematuria. One case was in stage Ⅰ （T1N0M0）, five cases were in stage Ⅱ （T2N0M0）, throe cases were in stage Ⅲ （T3N0M0,T4aN0M0）,and four cases wre in stage Ⅳ （T4b Nx Mx ）. Of all cases, nine patients （69.23 % ） had non - radical surgery combined with postoperative adjuvant systemic chemotherapy, and 1 -year, 3 -year, 5 -year disease -specific survival rates were 88.89% , 44.44% and 44.44% , respectively. Conclusions For non - locally advanced tumor, surgery combined with postoperative adjuvant systemic chemotherapy as the first choice. Neoadjuvant chemotherapy may be a better choice. Besides, the bladder - preserving operations is also a choice for patients.