长期留置导尿患者膀胱鳞癌的特征

目的回顾性分析长期留置导尿患者其膀胱鳞状细胞癌的临床特点,提高对这一较少见疾病的认识.方法以肿瘤、癌、膀胱癌、鳞状细胞癌、膀胱造口术和脊髓损伤作为关键词或主题词于 PubMed 数据库检索关于膀胱鳞状细胞癌的相关文章并加以分析.结果检索到1967年至2015年共89篇相关文章,其中29篇入选.涉及患者80例,患者诊断膀胱鳞癌时的平均年龄为55岁.留置导尿管持续时间为(23．9±10．3)年.留置导尿的主要原因是脊髓损伤(90％).与典型的移行细胞癌相比,通过膀胱镜或尿细胞学检查均仅能确定32．5％的肿瘤病变.膀胱鳞癌患者平均生存时间为(84±23．97)个月,95％可信区间为37．01~130．99个月.2年总生存率为67％,5年生存率为52％,10年生存率为40％.生存时间与疾病的分期、患者的年龄、留置导尿持续时间和治疗方式显著相关(P ＜0．05)；存活时间最长的是分期为 T1~2、诊断膀胱癌时年龄≥50岁以及采用根治性膀胱切除和/或放射治疗的患者(P ＜0．05).多变量分析表明,患者的年龄、留置导尿持续时间和治疗方案是影响生存的独立预测指标(P ＜0．05).结论长期留置导尿的膀胱鳞癌患者总体预后差,预后有赖于肿瘤的早期诊断.对高危患者定期行膀胱镜检查并随机活检,有望早期诊断长期留置导尿的膀胱癌患者.根治性膀胱切除与辅助放射治疗是目前最有效的治疗方式.

Squamous cell carcinoma of the bladder in patients with long-term catheter drainage

Objective In order to fully understand the clinical characteristics (SCC)of squa-mous cell carcinoma of the bladder,we review cases reported in patients with long-term catheter drainage.SCC of the bladder is a rare condition. Methods A search of published data was per-formed using the key words,bladder cancer,carcinoma,squamous cell carcinoma,cystostomy, vesicostomy and spinal cord injury.The PubMed databases were searched.All articles reported from the PubMed databases were reviewed. Results Overall,we identified 89 papers reported between 1 967 and 201 5.A total of 29 articles were identified and included as the evidence base for this review. The median age at diagnosis was 55 years.The means of duration of bladder management time was (23.9±10.3)years.The reason of indwelling cather was the spinal cord injury(90%).Unlike typical urothelial carcinomas,the tumorous lesions could be identified by cystoscopy or by urine cytology in 32.5% of cases.The mean survival time was (84±23.97)months,95% CI (37.01-130.99 months). Overall survival rates at 2 years were 67%.The 5-year survival rate was 52%.The 10-year survival rate was 40%.Survival time correlated with the stage of the disease,age of patients,duration of bladder management time,and the treatment regimen;survival time was highest among patients with T1-2 disease,<50 years old,radical cystectomy and radical cystectomy plus irradiation(P <0?05). Multivariate analysis revealed that duration of bladder management time,age of patients and the treatment regimen were significant independent predictors of poor survival. Conclusions Although the overall prognosis of this condition is poor,it is still dependent on the tumor stage at diagnosis. With early diagnosis and intervention ,it may be possible to achieve long - term survival .Screening cystoscopy and/or bladder biopsies in high-risk patients remains the alternative to find preclinical bladder cancer in patients with long-term catheter drainag.Radical cystectomy with adjunctive radiotherapy is by far the most acceptable therapy.