Current status of diagnosis and treatment of bladder cancer in China-Analyses of Chinese Bladder Cancer Consortium database

Objective:To investigate current status of diagnosis and treatment of bladder cancer in China.Methods:A database was generated by Chinese Bladder Cancer Consortium(CBCC).From January 2007 to December 2012,14,260 cases from 44 CBCC centers were included.Data of diagnosis,treatment and pathology were collected.Results:The average age was 63.5 year-old and most patients were male(84.3%).The most common histologic types were urothelial carcinoma(91.4%),adenocarcinoma(1.8%),and squamous carcinoma(1.9%).According to 1973 and 2004 WHO grading system,42.0%,41.0%,and 17.0% of patients were grade 1,2,and 3,and 16.0%,48.7%,and 35.3% of patients were papillary urothelial neoplasms of low malignant potential,low,and high grade,respectively.Non-muscle invasive bladder cancer(NMIBC)and muscle invasive bladder cancer(MIBC)were 25.2% and 74.1%,respectively(0.8% not clear).Carcinoma in situ was only 2.4%.Most patients were diagnosed by white-light cystoscopy with biopsy(74.3%).Fluorescence and narrow band imaging cystoscopy had additional detection rate of 1.0% and 4.0%,respectively.Diagnostic transurethral resection(TUR)provided detection rate of 16.9%.Most NMIBCs were treated with TUR(89.2%).After initial TUR,2.6%accepted second TUR,and 45.7%,69.9%,and 58.7% accepted immediate,induced,and maintenance chemotherapy instillation,respectively.Most MIBCs were treated with radical cystectomy(RC,59.7%).Laparoscopic RCs were 35.1%,while open RC 63.4%.Extended and standard pelvic lymph node dissection were 7% and 66%,respectively.Three most common urinary diversions were orthotopic neobladder(44%),ileal conduit(31%),and ureterocutaneostomy(23%).Only 2.3% of patients accepted neo-adjuvant chemotherapy and only 18%of T3 and T4 patients accepted adjuvant chemotherapy.Conclusion:Disease characteristics are similar to international reports,while differences of diagnosis and treatment exist.This study can provide evidences for revisions of the guideline on bladder cancer in China.

局麻下利用软性膀胱镜联合铥激光治疗麻醉高风险膀胱肿瘤患者的经验

目的探讨高龄、麻醉高风险患者在局麻(尿道黏膜麻醉)或无麻醉下利用膀胱软镜行铥激光膀胱肿瘤切除术(ThuLRBT)治疗的可行性。方法天津医科大学第二医院2020年6月至2022年1月共12例经评估一般状态较差、麻醉手术风险较大的高龄膀胱癌患者,利用膀胱软镜行局麻下铥激光膀胱肿瘤切除治疗。术前利用麻醉分级、Essen卒中风险评分量表、运动耐量、改良心脏危险指数评分及心脏并发症发生率综合评估患者全麻术中及术后风险,利用Karnofsky功能状态评分标准、年龄校正察尔森合并症指数及衰弱筛查量表评分数粗略预测术后恢复情况及手术价值。术中即刻利用疼痛数字评分法评估患者耐受情况,同时收集术后尿管留置时间、术后住院时间、并发症发生情况等。术后随访至2023年1月或患者复发。结果所有患者术中均未出现闭孔神经反射及膀胱穿孔等并发症,术后未出现持续膀胱出血及膀胱填塞。即刻疼痛评分(NRS)0~7分,中位评分2分。所有患者均可耐受手术过程,且痛苦较小。术后中位尿管留置时间2 d。术后中位住院时间2 d。术后12例患者定期随访,随访时间3~19个月,其中1例失访,1例患者术后5个月复发,1例患者术后13个月复发。结论ThuLRBT治疗麻醉高风险的高龄膀胱肿瘤患者是一种相对安全有效的治疗方式,其并发症少,患者耐受良好,近期疗效满意。