原发性膀胱小细胞癌的诊治体会和预后分析

目的:探讨膀胱小细胞癌(SCCB)的临床病理特点,提高对该病的认识和诊治水平。方法:回顾性分析我院2005年4月~2013年7月收治的10例原发性SCCB患者的临床病理资料。男9例,女1例,年龄45~78岁,平均63岁。以无痛肉眼血尿症状入院7例,膀胱刺激征入院1例,体检发现膀胱占位入院2例。其中尿脱落细胞学检查提示5例阳性,2例可疑,3例阴性。B超和CT检查均提示膀胱内占位性病变,CT检查提示盆腔淋巴结增大3例。膀胱镜检查提示:1例膀胱右侧壁与三角区交界处呈苔藓样变(直径约7~10cm),1例膀胱壁右侧顶底交界处及右颈部可见直径约2cm乳头样肿物,余8例可见肿瘤基底较宽,分布与B超结果一致。肿瘤最大径3.0~6.0cm,平均4.5cm。9例患者接受手术治疗,其中经尿道膀胱肿瘤电切术4例,膀胱部分切除1例,根治性膀胱切除4例;行单纯化疗1例。总计9例患者接受1~6个周期全身化疗。结果:所有患者术后病理证实为原发性SCCB。参照第七版美国肿瘤研究联合委员会(AJCC)膀胱癌分期标准,10例患者临床分期为:Ⅰ期1例,Ⅱ期3例,Ⅲ期4例,Ⅳ期2例。患者均获随访,随访时间3~47个月不等。仅1例患者术后存活47个月至今,另外9例患者死亡,平均存活时间为11.7个月。结论:SCCB是一种分化程度低、恶性度高、易早期转移、预后较差的少见肿瘤。该病最佳治疗方式及预后判断的指标尚不明确,简单的肿瘤二期分期系统更适于该病的治疗,但需多中心前瞻性随机试验进一步证实。分子靶向治疗是未来的努力方向。

Analysis of diagnosis and treatment and prognosis of primary small cell carcinoma of the urinary bladde

Objective：To discuss the clinical manifestation and pathology of small cell carcinoma of the urinary bladder（SCCB）and to improve the early diagnosis of SCCB.Method：From April 2005to July 2013,the clinical and pathologic data of 10patients（including 9males and 1female with the mean age of 63years ranging from 45to 78years）with SCCB were retrospectively analyzed in combination with review of literatuer.7patients presented with symptoms of gross hematuria,1patient had bladder irritation and the rest 2patients had no symptoms.All the patients were diagnosised of bladder space-occupying lesions after Ultrasound and CT examination and CT showed pelvic lymph node swelling in 3patients.The mean diameter of the tumors was 4.5cm（range 3.0-6.0cm）.Of the 10cases,4patients underwent transurethral resection of bladder tumer,1case underwent partial cystectomy and 4cases underwent radical cystectomy.The rest 1patient only received chemothreapy.9of them underwent 1-6courses of chemothreapy.Result：All patients had pathological diagnosis of SCCB.According to AJCC guidline,the clinical stages were as follows,1case in stageⅠ,3cases in stageⅡ,4cases in stageⅢand 2cases in stageⅣ.All the 10patients were followed-up from 3months to 47months,only 1patient survived after 47months and the other 9patients had died.These deceased patients survived an average of 11.7months.Conclusion：SCCB is a rare condition,and most of the presented cases have poorly differentiated,highly malignancy,easily metastasizes and poor prognosis.A simpler staging system（limited stage vs extensive stage）may be appropriate for the SCCB patients.The standard treatment outlines and prognostic indicators of SCCB have not been well established,and prospective,multi-institutional,randomized studies are required to assess them.Novel targeted therapies and identification of new molecular markers for early diagnosis may play an important role in the future.