The majority of bladder cancers(BCs)are non-muscle invasive BCs(NMIBCs)and show the morphology of a conventional urothelial carcinoma(UC).Aberrant morphology is rare but can be observed.The classification and characte...The majority of bladder cancers(BCs)are non-muscle invasive BCs(NMIBCs)and show the morphology of a conventional urothelial carcinoma(UC).Aberrant morphology is rare but can be observed.The classification and characterization of histologic subtypes(HS)in UC in BC have mainly been described in muscle in-vasive bladder cancer(MIBC).However,the currently used classification is ap-plied for invasive urothelial neoplasm and therefore,also valid for a subset of NMIBC.The standard transurethral diagnostic work-up misses the presence of HS in NMIBC in a considerable percentage of patients and the real prevalence is not known.HS in NMIBC are associated with an aggressive phenotype.Conse-quently,clinical guidelines categorize HS of NMIBC as“(very)high-risk”tumors and recommend offering radical cystectomy to these patients.Alternative strategies for bladder preservation can only be offered to highly selected patients and ideally within clinical trials.Novel treatment strategies and biomarkers have been established MIBC and NMIBC but have not been comprehensively invest-igated in the context of HS in NMIBC.Further evaluation prior to implementation into clinical practice is needed.展开更多
目的:观察术前新辅助化疗治疗浸润性膀胱癌的临床疗效。方法:对27例平均年龄68岁、有全膀胱切除指征而无法耐受或不愿接受膀胱全切的浸润性膀胱癌患者行骼内动脉化疗并栓塞联合手术治疗,观察膀胱保留率、降级降期率、肿瘤复发率,Kaplan-...目的:观察术前新辅助化疗治疗浸润性膀胱癌的临床疗效。方法:对27例平均年龄68岁、有全膀胱切除指征而无法耐受或不愿接受膀胱全切的浸润性膀胱癌患者行骼内动脉化疗并栓塞联合手术治疗,观察膀胱保留率、降级降期率、肿瘤复发率,Kaplan-Meier法计算总生存率、无瘤生存率,并绘制生存曲线。结果:髂内动脉化疗、栓塞后,22例患者膀胱肿瘤缩小约81.5%,无变化5例;肿瘤临床分期降低21例(有效率77.8%),无变化6例;病理分级降低12例(降级率44.4%),分级不变15例。共24例患者得以保留膀胱,其中21例行经尿道膀胱肿瘤切除术(transurethral resection of the bladder,TURB),3例行膀胱部分切除术(膀胱保留率88.9%)。3例接受根治性膀胱全切术。术后1、2、3、5年分别复发4例(14.8%)、7例(25.9%)、11例(40.7%)、14例(51.9%)。2例随访11个月和23个月发现肿瘤远处转移后死亡,1例膀胱切口种植转移,局部切除后再发,带瘤生存,术后3年死于肿瘤进展,2例腺癌5年内死于肿瘤进展。至随访截止日期,死于术后肿瘤进展共5例。27例患者1、2、3、5年无瘤生存率分别为88.9%、73.6%、58.1%、41.4%,5年总生存率66.0%。结论:有选择地对部分浸润性膀胱癌患者施行术前髂内动脉灌注化疗、栓塞,联合手术等综合性治疗措施以保留功能性膀胱确实可行,但合理评价其在浸润性膀胱癌治疗中的应用价值尚需要进一步研究证实。展开更多
文摘The majority of bladder cancers(BCs)are non-muscle invasive BCs(NMIBCs)and show the morphology of a conventional urothelial carcinoma(UC).Aberrant morphology is rare but can be observed.The classification and characterization of histologic subtypes(HS)in UC in BC have mainly been described in muscle in-vasive bladder cancer(MIBC).However,the currently used classification is ap-plied for invasive urothelial neoplasm and therefore,also valid for a subset of NMIBC.The standard transurethral diagnostic work-up misses the presence of HS in NMIBC in a considerable percentage of patients and the real prevalence is not known.HS in NMIBC are associated with an aggressive phenotype.Conse-quently,clinical guidelines categorize HS of NMIBC as“(very)high-risk”tumors and recommend offering radical cystectomy to these patients.Alternative strategies for bladder preservation can only be offered to highly selected patients and ideally within clinical trials.Novel treatment strategies and biomarkers have been established MIBC and NMIBC but have not been comprehensively invest-igated in the context of HS in NMIBC.Further evaluation prior to implementation into clinical practice is needed.
文摘目的:观察术前新辅助化疗治疗浸润性膀胱癌的临床疗效。方法:对27例平均年龄68岁、有全膀胱切除指征而无法耐受或不愿接受膀胱全切的浸润性膀胱癌患者行骼内动脉化疗并栓塞联合手术治疗,观察膀胱保留率、降级降期率、肿瘤复发率,Kaplan-Meier法计算总生存率、无瘤生存率,并绘制生存曲线。结果:髂内动脉化疗、栓塞后,22例患者膀胱肿瘤缩小约81.5%,无变化5例;肿瘤临床分期降低21例(有效率77.8%),无变化6例;病理分级降低12例(降级率44.4%),分级不变15例。共24例患者得以保留膀胱,其中21例行经尿道膀胱肿瘤切除术(transurethral resection of the bladder,TURB),3例行膀胱部分切除术(膀胱保留率88.9%)。3例接受根治性膀胱全切术。术后1、2、3、5年分别复发4例(14.8%)、7例(25.9%)、11例(40.7%)、14例(51.9%)。2例随访11个月和23个月发现肿瘤远处转移后死亡,1例膀胱切口种植转移,局部切除后再发,带瘤生存,术后3年死于肿瘤进展,2例腺癌5年内死于肿瘤进展。至随访截止日期,死于术后肿瘤进展共5例。27例患者1、2、3、5年无瘤生存率分别为88.9%、73.6%、58.1%、41.4%,5年总生存率66.0%。结论:有选择地对部分浸润性膀胱癌患者施行术前髂内动脉灌注化疗、栓塞,联合手术等综合性治疗措施以保留功能性膀胱确实可行,但合理评价其在浸润性膀胱癌治疗中的应用价值尚需要进一步研究证实。
