摘要
目的评价保留女性生殖器官的根治性膀胱切除术的长期疗效。方法回顾性分析1990—2010年保留女性生殖器官的根治性膀胱切除并且有完整随访结果的病例55例，年龄25～82岁，平均63岁。随访时间12个月～19年，平均55个月。单发肿瘤49例，多发6例。初发肿瘤39例，复发16例。病理类型：尿路上皮癌49例，鳞状细胞癌3例，腺癌2例，膀胱癌肉瘤1例。病理分期：原位癌1例，pT1 18例，pT2 16例，pT3 14例，pT4 4例，标本中未见到癌2例（pT0）。盆腔淋巴结阳性9例，侵犯淋巴血管7例。对可能影响生存率的8项临床病理指标（年龄、吸烟史、初发与复发、单发与多发、肿瘤分级、分期、盆腔淋巴结状态及淋巴血管侵犯）进行单因素及多因素生存分析。结果55例患者3、5、10年总生存率（overall survival，OS）分别为61％、54％和42％；3、5、10年癌特异生存率（cancer specific survival，CSS）分别为65％、61％和61％。病理分期≤pT2N0M0者的5年CSS和OS分别为84％和72％，病理分期≥pT3N0M0者分别为29％和29％；淋巴结阳性患者的3年CSS和OS分别为28％和28％。单因素分析显示年龄≥65岁、肿瘤病理分期≥pT3、盆腔淋巴结阳性、肿瘤多发、肿瘤侵犯神经血管与CSS显著相关，COX回归分析显示仅肿瘤的病理分期（HR=3．992，P=0．011）及盆腔淋巴结状态（HR=3．877，P=0．019）与CSS显著相关。结论保留女性生殖器官的根治性膀胱切除术后CSS与膀胱癌的病理分期及淋巴结状态显著相关，是遴选适宜此术式患者的最关键参考指标。保留女性生殖器官的根治性膀胱切除是治疗器官局限性膀胱癌（≤pT2N0M0）安全可靠的手术方式，在最大程度保留女性功能及生活质量的同时可以取得理想的肿瘤治疗效果，但对病理分期≥pT3N0M0（不包括侵犯子宫或阴道的T4期患者）及盆腔淋巴结阳性病例，尚需更多的临床病例来验证其合理性。
Objective To report a series of female patients with bladder cancer who underwent gynecologic-tract sparing radical cystectomy with long term follow-up. Methods Fifty-five female patients between the ages of 25 and 82 years who underwent gynecologic-tract sparing radical cystectomy between 1990 and 2010 were reviewed retrospectively. Pathologic characteristics and survival （overall and cancerspecific） were reported. Survival was estimated using Kaplan-Meier methods, and Cox proportional hazards regression analyses were performed to determine factors associated with mortality. Results Five patients were lost in follow up. Fifty-five women with a mean follow-up of 55.2 months were analyzed. The 3, 5 and 10-year cancer specific survival （CSS） was 65% , 61% and 61% , respectively, and the corresponding overall survival （OS） was 61% , 54% and 42% , respectively. For patients with organ confined disease （ ≤ pT2N0M0） the 5-year CSS and OS was 84% and 72% , while for those with non organ confined disease （ ≥ pT3N0M0） the 5-year CSS and OS reduced to 29% and 29%. Pathologic lymph node status （HR =3. 877, P = 0. 019 ） and pathologic staging （ HR = 3. 992, P = O. 011 ） were the only clinical or pathologic characteristics significantly associated with survival. Conclusions For patients with pathologically organ-confined bladder cancer （ ≤ pT2N0M0 ） , gynecologic-tract sparing radical cystectomy is an oncologically safe treatment modality, while for those with ≥ pT3N0M0 or positive pelvic lymph nodes, gynecologic-tract sparing radical cystectomy may need large scale randomized control trials to justify its validity, pathological stage and lymph node status are the most important key points when choosing appropriate patients.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2012年第5期351-355,共5页
Chinese Journal of Urology
关键词
膀胱肿瘤
癌
女性
膀胱切除术
回顾性研究
Urinary bladder neoplasms
Carcinoma
Female
Cystectomy
Retrospective studies
