吡柔比星(THP)膀胱灌注预防膀胱癌术后复发的疗效观察

目的;分析１９９８年６月－１９９９年８月间２２例浅表性膀胱癌患者行膀胱部分切除术或行ＴＵＲ－Ｂｔ及电灼术后采用吡柔比星膀胱灌注预防肿瘤复发。方法：ＴＨＰ３０ｍｇ,每周一次,连用８周,而后每月１次,连用８个月。结果：总疗程１０个月,平均随访９．７个月,复发率１３．６％。结论：ＴＨＰ用于临床,效果好,不良反应少,给药方便,值得临床推广应用。     

丝裂霉素膀胱灌注预防浅表性膀胱肿瘤复发的远期疗效观察

目的 观察丝裂霉素预防浅表性膀胱肿瘤复发的远期疗效。方法 将１９８０年１月￣１９９１年１２月的８６例浅生膀胱肿瘤患者分为丝裂霉素组（手术＋丝裂霉素灌注）和对照组（单纯手术）,对两组的肿瘤术后复发率、病理分期和细胞分级进行对比观察。结果 丝霉素组７１例,对照组１５例,术后肿瘤复发率分别为４０．８％和６６．７％。丝裂霉素组在术后６月、１２月、２４月、３６月和６０月以上的无瘤率分别为８５．９％,７６．１     

THP与MMC膀胱灌注预防膀胱癌术后复发的疗效观察

１９９７年５月～２０００年５月,我院共收治膀胱癌８４例。为预防膀胱癌术后复发,随机将患者分为两组,一组术后膀胱内灌注吡柔比星（ＴＨＰ组）４８例,另一组灌注丝裂霉素（ＭＭＣ组）３６例。现将两组疗效进行对比分析,报告如下。１材料与方法１．１临床资料本文８４例,男６０例,女２４例,年龄２７～８０岁,平均５８．２岁。初发７６例,复发８例。单发肿瘤７８例,多发肿瘤６例。膀胱部分切除术后６０例,单纯肿瘤切除术后１４例,ＴＵＲＢｔ１０例。病理检查均为膀胱移行细胞癌。病理分级为Ｇ１３５例,Ｇ２３９例,Ｇ３１０例…     

透明质酸酶增强５-ＦＵ对结肠癌抗癌作用的动物实验研究

目的：观察透明质酸酶（Ｈｙａｌｕｒｏｎｉｄａｓｅ,Ｈｙａｓｅ）在氟尿嘧啶（５-ＦＵ）对裸小鼠结肠癌移植瘤生长影响中的作用,并探讨其作用的可能机制。方法：１８只雄性裸小鼠左侧腹壁皮下移植三维培养人结肠癌ＨＴ-２９细胞,随机分为６组,每组３只：Ⅰ组（对照组）、Ⅱ组［Ｈｙａｓｅ２００Ｕ／（ｋｇ·ｄ）］、Ⅲ组［５-ＦＵ３０ｍｇ／（ｋｇ·ｄ）］、Ⅳ组［Ｈｙａｓｅ５０Ｕ／（ｋｇ·ｄ）＋５-ＦＵ３０ｍｇ／（ｋｇ·ｄ）］、Ⅴ组［Ｈｙａｓｅ１００Ｕ／（ｋｇ·ｄ）＋５-ＦＵ３０ｍｇ／（ｋｇ·ｄ）］和Ⅵ组［Ｈｙａｓｅ２００Ｕ／（ｋｇ·ｄ）＋５-ＦＵ３０ｍｇ／（ｋｇ·ｄ）］,Ｈｙａｓｅ于肿瘤细胞移植处第１、５天皮下注射,５-ＦＵ于第１～５天右侧腹腔注射。每周以游标卡尺测定瘤体最长径和最短径,计算肿瘤体积和抑瘤率,第６周杀鼠称瘤重,取瘤组织行ＨＥ染色,Ｗｅｓｔｅｒｎｂｌｏｔｔｉｎｇ法检测瘤组织中Ｅ-钙黏素（Ｅ-ｃａｄｈｅｒｉｎ）、细胞间黏附分子-１（ＩＣＡＭ-１）和ＮＦ-κＢｐ６５蛋白的表达并对蛋白条带的光密度（ＯＤ）进行半定量分析。结果：裸小鼠均成功移植皮下肿瘤,与对照组（Ⅰ组）比较,单纯Ｈｙａｓｅ治疗组（Ⅱ组）肿瘤体积减小不明显（Ｐ＞０.０５）,单纯５-ＦＵ治疗组（Ⅲ组）自第３周开始肿瘤体积明显减小（Ｐ＜０.０５）,而不同剂量Ｈｙａｓｅ联合５-ＦＵ治疗组（Ⅳ、Ⅴ、Ⅵ组）瘤体积减小更明显（Ｐ＜０.０５）;与单纯５-ＦＵ治疗组（Ⅲ组）比较,第３周开始联合治疗组（Ⅳ、Ⅴ、Ⅵ组）瘤体积明显减小（Ｐ＜０.０５）;第６周Ⅱ ～Ⅵ组抑瘤率分别为６.８％、１７.５％、３４.１％、４６.３％和５６.６％;Ⅲ ～Ⅵ组瘤重均低于Ⅰ组（Ｐ＜０.０５或Ｐ＜０.０１）;Ⅱ、Ⅳ、Ⅴ、Ⅵ组瘤组织内Ｅ-ｃａｄｈｅｒｉｎ和ＩＣＡＭ-１蛋白条带ＯＤ值均较Ⅰ组有不同程度减低,而ＮＦ-κＢｐ６５蛋白条带ＯＤ值在各组间无明显变化（Ｐ＞０.０５）。结论：透明质酸酶可能通过抗细胞黏附在结肠癌化疗中具有增敏作用。     

IL—2膀胱内注射及BCG＋IL—2联合膀胱灌注预防膀胱癌复发

目的　为预防膀胱癌术后复发。方法　对４０例膀胱癌患者于术中或ＴＵＲＢＴ术后癌肿切缘周围组织粘膜下注射５０万ｕ ＩＬ－ ２，以后每３ 月定期用自制输尿管导管针注射。并联合应用ＢＣＧ１２０ ｍ ｇ＋ ＩＬ－ ２１０ｕ 膀胱内灌注。同时随机对３０例同期膀胱癌术后患者用丝裂霉素Ｃ４０ｍｇ 膀胱内灌注为对照组。结果　随访４－ ７２个月，平均２８．６ 个月。无肿癌复发率ＩＬ－ ２膀胱内注射及ＩＬ－２＋ ＢＣＧ灌注组９５％ ，丝裂霉素Ｃ灌注组（对照组）８６．７％ 。比较两组有显著性差异（Ｐ＜ ０．０５）。结论　ＩＬ－ ２ 膀胱内注射及ＢＣＧ＋ ＩＬ－ ２ 联合膀胱内灌注防止膀胱癌术后复发更为有效。内注射ＩＬ－ ２，并于术后２ 周开始用ＢＣＧ＋ ＩＬ－ ２ 联合膀胱内灌注，这样可使血和尿ＩＬ－ ２ 水平长时间增高，且可有效观察肿瘤是否复发，可以充分发挥ＩＬ－ ２淋巴因子对肿瘤细胞的杀伤作用，ＢＣＧ还可使膀胱粘膜移行细胞变薄，刺激Ｔ细胞增殖转化成特异性细胞毒性Ｔ细胞，使局部呈炎性反应。我们行膀胱镜检时发现ＩＬ２ 膀胱内注射及ＢＣＧ＋ ＩＬ２ 膀胱灌注３ 月左右，病人的膀胱粘膜失去正常结构，膀胱粘膜变白，表面有炎性渗出物，呈“板块状”，弹性差，组织脆弱，这     

大肠癌有丝分裂关卡基因ＢＵＢ１和ＢＵＢＲ１ ｍＲＮＡ的表达分析

目的　研究大肠癌组织中有丝分裂关卡基因ＢＵＢ１和ＢＵＢＲ１ｍＲＮＡ的表达。方法　采用半定量ＲＴ-ＰＣＲ方法检测３６例大肠癌和癌旁正常组织中ＢＵＢ１和ＢＵＢＲ１ｍＲＮＡ表达水平。结果　大肠癌和癌旁正常组织中的ＢＵＢ１ｍＲＮＡ拷贝数／β-ａｃｔｉｎｍＲＮＡ拷贝数比值分别为０.６７±０.３３和１.２４±０.３７;大肠癌和癌旁正常组织中的ＢＵＢＲ１ｍＲＮＡ拷贝数／β-ａｃｔｉｎｍＲＮＡ拷贝数比值分别为０.５３±０.２５和１.０３±０.４８。ＢＵＢ１和ＢＵＢＲ１ｍＲＮＡ的表达水平在大肠癌中显著低于癌旁正常组织（Ｐ＜０.０５）。结论　ＢＵＢ１和ＢＵＢＲ１基因是大肠癌的肿瘤相关基因,可能在大肠癌发病中具有重要作用。     

尼妥珠单抗对耐多西紫杉醇人肺腺癌细胞株化疗敏感性的调变作用

目的　通过体内外实验研究人源化抗表皮生长因子受体（ＥＧＦＲ）单抗尼妥珠（ｈ-Ｒ３）对耐多西紫杉醇（ＤＴＸ）人肺腺癌细胞株（ＳＰＣ-Ａ１／ＤＴＸ）化疗敏感性的调变作用。方法　免疫组化法及流式细胞仪测定人肺腺癌细胞株ＳＰＣ-Ａ１和ＳＰＣ-Ａ１／ＤＴＸ肺腺癌细胞株表面ＥＧＦＲ的表达强度,突变富集液相芯片法检测其ＥＧＦＲ、Ｋ-Ｒａｓ和ＰＩ３ＫＣＡ基因的突变情况,流式细胞仪检测ｈ-Ｒ３对细胞周期的影响以及ｈ-Ｒ３联合ＤＴＸ对细胞凋亡的影响,ＭＴＴ法检测ｈ-Ｒ３与ＤＴＸ的联合指数（ＣＩ）,裸鼠ＳＰＣ-Ａ１／ＤＴＸ移植瘤模型观察联合组及单药组对裸鼠抑制瘤模型肿瘤的增殖情况并计算瘤重抑制率（ＴＷＩ）。结果　ＳＰＣ-Ａ１细胞株ＥＧＦＲ表达强度为（＋,２１.5３％）,ＳＰＣ-Ａ１／ＤＴＸ细胞株为（＋＋＋,９２.４７％）;ＳＰＣ-Ａ１／ＤＴＸ细胞株的ＰＩ３ＫＣＡ基因外显子２０突变,ＳＰＣ-Ａ１细胞株无突变。ｈ-Ｒ３作用２４ｈ后,ＳＰＣ-Ａ１／ＤＴＸ细胞Ｇ１ 期阻滞较ＳＰＣ-Ａ１细胞更显著（Ｐ＝０.０００２）;ｈ-Ｒ３及ＤＴＸ联合用药后ＳＰＣ-Ａ１／ＤＴＸ细胞株的凋亡率为（２４.７±０.５）％,明显高于ｈ Ｒ３单药组的（１４.５±０.１）％,而单用ＤＴＸ后的凋亡率无显著升高,ＳＰＣ-Ａ１细胞株单药组及联合组凋亡率均有升高（Ｐ＜０.０５）;１００μｇ／ｍｌ及２００μｇ／ｍｌｈ Ｒ３与ＤＴＸ联合对ＳＰＣ-Ａ１或ＳＰＣ-Ａ１／ＤＴＸ细胞株的增殖抑制具有协同作用;联合组对ＳＰＣ-Ａ１／ＤＴＸ肺腺癌荷瘤裸鼠的ＴＷＩ为７１.７％,高于ＤＴＸ组的５２.６％和ｈ-Ｒ３组的３６.９％。结论　ｈ-Ｒ３能明显增加耐ＤＴＸ的人肺腺癌细胞株化疗的敏感性,其机制可能为ｈ-Ｒ３具有Ｇ１期阻滞和逆转耐药细胞凋亡抵抗的作用,并且其疗效与耐药细胞较亲本细胞的ＥＧＦＲ表达增强有关,而耐药细胞的ＰＩ３ＫＣＡ基因突变对疗效的影响不显著。     

T1G3膀胱尿路上皮癌保留膀胱综合治疗的疗效评价

 目的 探讨保留膀胱的局部切除联合动脉化疗治疗T1G3膀胱尿路上皮癌的疗效。 方法　对35例T1G3膀胱尿路上皮癌患者行保留膀胱的肿瘤切除,术后辅助3次动脉化疗,所有患者均行规范膀胱灌注化疗。 结果　35例患者术后随访7～116个月,平均随访（66.0±18.3）个月,术后5年肿瘤复发率48.6 %（17／35）,膀胱保留率68.6 %（24／35）,总生存率77.1 ％（27／35）,肿瘤特异性生存率82.9 ％（29／35）,动脉化疗无严重并发症发生。结论　T1G3膀胱尿路上皮癌保留膀胱综合治疗不但可以维持正常的膀胱功能,降低复发率,而且不会降低患者的生存率,是可选择的有效治疗手段,避免部分患者行膀胱全切的过度治疗。     

EBER1／2,LMP—1在NK／T在NK／T细胞淋巴瘤中的表达

目的探讨ＮＫ／Ｔ细胞淋巴与ＥＢ病毒（ＥＢＶ）的关系。方法收集２６例ＮＫ／Ｔ细胞淋巴瘤（淋巴结内１０例,淋巴结外１６例）,采用免疫组化学Ｓ－Ｐ法确定瘤细胞本质,用原位杂交法检测ＥＢＶ编码的ＲＮＡ（ＥＢＥＲ１／２）。结果①在２６例ＮＫ／Ｔ细胞淋巴瘤中,ＥＢＥＲ１／２检出率为４６．２％（１２／２６）,其中淋巴瘤中,ＥＢＥＲ１／２在鼻腔检出率为９０．０％（９／１０）,其它部位为３３．３％（２／６）,２组比     

膀胱癌增殖细胞核抗原及花生凝集素受体对比研究

目的寻求对膀胱癌的诊断和预后有意义的肿瘤标记物。方法应用免疫组化ＡＢＣ法对６３例膀胱移行细胞癌（ＴＣＣ０行花生凝集素（ＰＮＡ）受体和增殖细胞核抗原（ＰＣＮＡ）染色检测。结果ＰＮＡ受体在膀胱癌Ｇ１、Ｇ２和Ｇ３中的强阳性表达率分别为５４．５５％、８５．７％和１００％，而ＰＣＮＡ的强阳性表达率为１８．２％、８０．７％和９２．３％；ＰＮＡ受体和ＰＣＮＡ在Ｔ２－Ｔ４期中为９３．５％和８０．６％；５年生 率比     

保留膀胱的综合治疗与根治性手术治疗肌层浸润性膀胱癌预后的荟萃分析

目的 比较保留膀胱手术+术后化疗与根治性手术治疗肌层浸润性膀胱癌的预后.方法 检索保留膀胱手术+术后化疗与根治性手术治疗肌层浸润性膀胱癌(muscle-invasive bladder cancer,MIBC)的对照研究,比较两种治疗方案的术后5年生存率,计算合并优势比(OR)和95%CI.结果 共纳入7项研究,累积876例患者.1组研究的OR=1.03,95%CI为1.03(0.52~2.02),4组研究的OR及其95%CI﹤1,2组研究的OR及其95%CI﹥1;7个研究的总OR=1.05,95%CI为1.05(0.53~2.06),跨过"无差异线",故认为根治性膀胱全切术(radical cystectomy,RC)与保留膀胱的综合治疗预后差异无统计学意义(Z=0.13,P=0.89).结论 对于部分肌层浸润性膀胱癌患者,保留膀胱的综合治疗不会降低患者的5年生存率,且能保留患者膀胱的正常功能,提高了患者的生存质量,但适应证需严格把握.     

肌层浸润性膀胱癌保留膀胱综合治疗的疗效评价研究

目的 评价髂内动脉灌注化疗+经尿道膀胱肿瘤电切术+膀胱内灌注化疗综合治疗肌层浸润性膀胱癌的临床疗效.方法 比较64例采用髂内动脉灌注化疗(吡柔比星40 mg/m2、5-FU 1000 mg/m2、羟喜树碱30 mg/m2)+经尿道膀胱肿瘤电切术+膀胱内灌注化疗(综合治疗组)和62例采用经尿道膀胱肿瘤电切术+膀胱内灌注化疗(对照组)的肌层浸润性膀胱癌(T2N0M0期)患者经治疗后的肿瘤复发/转移率、死亡率及治疗相关不良反应的发生情况.结果 至随访截至日期,综合治疗组的无复发/转移率为93.75%(60/64),明显高于对照组的45.16%(28/62),差异有统计学意义(P=0);转移死亡率为3.13%(2/64),低于对照组的16.13%(10/62),差异有统计学意义(P=0.015);非膀胱癌死亡率为10.94%(7/64),与对照组的12.90%(8/62)相比,差异无统计学意义(P﹥0.05).结论 髂内动脉灌注化疗+经尿道膀胱肿瘤电切术+膀胱内灌注化疗的综合治疗方案,能够降低肌层浸润性膀胱癌(T2N0M0)患者肿瘤复发率和死亡率,不增加非癌性死亡风险,值得进一步探讨.     

ZONAB在膀胱癌组织中的表达及其意义

目的:探讨膀胱癌组织中ZONAB的表达及意义。方法:收集2014年至2016年71位手术患者的膀胱癌以及对应的癌旁膀胱上皮标本,采用Realtime-PCR法、Western blot法、免疫组化法等检测ZONAB在膀胱癌组织与癌旁组织中的表达情况,并分析其与临床病理参数的关系,免疫组化法检测E-cadherin在膀胱癌组织中的表达并分析其与ZONAB表达的相关性。结果:Realtime-PCR法和Western blot法测得膀胱癌组织中ZONAB的表达水平高于癌旁组织,差异具有统计学意义（P＜0.05）;免疫组化法测得膀胱癌组织中的ZONAB表达率高（38.0%）大于癌旁组织（11.3%）,差异有统计学意义（P＜0.05）;肌层浸润性膀胱癌中ZONAB表达率较非肌层浸润性膀胱癌高（P＜0.05）;ZONAB与E-cadherin两种蛋白在膀胱癌中表达呈负相关（P＜0.05）。结论:ZONAB在膀胱癌中高表达,ZONAB的表达在肌层浸润性膀胱癌中高于非肌层浸润性膀胱癌,ZONAB的异常表达可能参与了膀胱癌的发生、发展。     

经尿道膀胱肿瘤电切术中活检的应用研究

目的：探讨膀胱肿瘤电切术（transurethral resection of bladder tumor,TURBT）中肿瘤基底部及边缘部位活检的应用价值及意义。方法收集2010年3月至2013年4月行 TURBT 术的膀胱癌患者58例,病理类型均为膀胱尿路上皮癌。术中活检28例（活检组）,活检部位包括肿瘤基底部和创面边缘可疑黏膜;未活检30例（未活检组）。观察两组术后1年肿瘤复发、进展情况。结果（1）活检组：1例活检发现肿瘤肌层浸润,行根治性全膀胱切除术;27例为非肌层浸润性尿路上皮癌,其中5例行二次TURBT ,包括3例活检未见肌层组织及2例活检见上皮异形增生,另22例活检未见异常。随访1年,肿瘤复发5例,进展2例。（2）未活检组：2例为肌层浸润性膀胱癌,28例为非肌层浸润性膀胱癌。随访1年,肿瘤复发10例,进展6例。结论TURBT 术中行肿瘤基底部及边缘可疑部位活检,有助于明确肿瘤分期分级,提高残余肿瘤的检出率,明确电切范围及深度,并为二次 TURBT 提供参考依据。     

肌层浸润性膀胱癌患者根治术后预后相关因素分析

目的:探讨肌层浸润性膀胱癌根治术预后相关因素。方法:回顾性分析156例腹腔镜下根治性膀胱全切除术及盆腔淋巴结清扫术后肌层浸润性膀胱癌患者生存数据,选择17种可能对预后产生影响的因素,采用Kaplan-Meier法及Cox比例风险模型统计分析。结果:单因素分析示年龄、肿瘤T分期、有无淋巴结转移、肾积水、是否侵犯输尿管下段、是否侵犯淋巴脉管、是否行新辅助化疗、术后辅助放化疗对患者预后的影响差异有统计学意义（P<0.05）。多因素分析示年龄（P<0.001）、肿瘤T分期（P=0.003）、淋巴结转移（P=0.031）、新辅助化疗（P=0.015）为肌层浸润性膀胱癌根治术预后影响因素。结论:年龄、肿瘤T分期、淋巴结转移为影响肌层浸润性膀胱癌根治术患者生存的独立危险因素。新辅助化疗是肌层浸润性膀胱癌根治术预后保护因素。     

Tissue factor expression correlates with disease-specific survival in patients with node-negative muscle-invasive bladder cancer

Tissue factor (TF), a transmembrane glycoprotein responsible for initiating the extrinsic pathway of blood coagulation plays a key role in cancer growth, metastasis and angiogenesis. Various studies have demonstrated the prognostic potential of TF expression in several cancers. However, its role in bladder cancer is unclear. This study evaluated the prognostic potential of TF expression in muscle-invasive bladder tumors from patients treated with radical cystectomies. Immunohistochemical staining using a monoclonal antibody (mAb) anti-TF was carried out on sections of tissue microarray blocks containing cores of muscle-invasive bladder tumors (4 cores/tumor) from 218 patients. The intensity of the staining was evaluated on a scale from 0 to 3 by two independent observers who were both unaware of the clinicopathological characteristics of the samples. TF was expressed in 77.6% of tumors, independently from baseline characteristics (age, gender, stage and grade) as assessed using the chi(2) and Student t tests. During follow-up (median: 2.6 years), 45.4% of the patients died from the progression of their cancer. Kaplan-Meier survival showed that among the 103 patients with node-negative (N0) transitional cell carcinoma (TCC), those with TF-positive tumors had shorter bladder cancer-specific survival (p = 0.0276). Moreover, multivariate Cox regression analysis showed they had a 3.15-fold greater risk of dying from bladder cancer (95% CI: 1.1-9.0; p = 0.032). In conclusion, TF expression was an independent predictor of disease-specific survival in N0 muscle-invasive TCCs treated by radical cystectomy and therefore, might help identify patients at higher risk of disease progression. These patients could potentially benefit from adjuvant chemotherapy.     

中性粒／淋巴细胞比值在正常人群及不同分期膀胱尿路上皮癌患者中的意义

目的:评估中性粒细胞与淋巴细胞比率（neutrophil-lymphocyte ratio,NLR）在膀胱尿路上皮癌（urothelial carcinoma,UC）患者及正常人群中的意义。方法:随访非肌层浸润性膀胱癌患者（non muscle-invasive bladder cancer,NMIBC）、肌层浸润性膀胱癌患者（muscle-invasive bladder cancer,MIBC）和健康体检患者。根据受试者工作曲线（receiver operator characteristic curve,ROC）确定不同类型膀胱癌患者术后是否出现复发及转移的最佳NLR值以及膀胱癌患者中NMIBC患者区别MIBC患者的最佳NLR值。收集患者T分期、G分级、肿瘤数量、复发时间、3年无复发生存率、无瘤生存率。结果:NLR值在正常健康人群及癌症患者中存在差异,在NMIBC患者及MIBC患者中存在差异（P＜0.05）。NLR值在NMIBC患者的肿瘤T分期、G分级、肿瘤大小、肿瘤数量、复发时间及无瘤生存时间中存在差异（P＜0.05）,在MIBC患者的肿瘤T分期中存在差异（P＜0.05）。结论:NLR值很可能为患者的疾病辅助诊断及预后提供一项经济可行的炎症标志物。     

Trimodal therapy for muscle-invasive bladder cancer

Introduction: Radical cystectomy is the standard therapy for patients with muscle-invasive bladder cancer. Organ-preserving surgical procedures have been established as alternatives to radical surgery for localized malignancies in other anatomic sites. Trimodal therapy consisting of radiation therapy, chemotherapy, and either transurethral resection of the bladder or partial cystectomy is an effective treatment for selected patients with muscle-invasive bladder cancer that allows for preservation of the urinary bladder.

Areas covered: This review provides an overview of the value of trimodal therapy in the treatment of muscle-invasive bladder cancer.

Expert commentary: Prerequisites for trimodal therapy for bladder cancer include: good bladder function, unifocal cT2 urothelial carcinoma of the bladder, and absence of hydronephrosis. Careful selection of patients and accurate assessment of the anatomic extent of the tumor is important for patient safety. The basis for successful trimodal therapy is complete transurethral resection of the tumor, followed by radiation therapy with concurrent radiosensitizing chemotherapy. Cystoscopic controls and follow-up biopsies should be performed at completion of adjuvant therapy or shortly after induction of trimodal therapy to identify nonresponders for whom salvage radical cystectomy may be indicated.     

Bladder-sparing, combined-modality approach for muscle-invasive bladder cancer: a multi-institutional, long-term experience

BACKGROUND: The authors evaluated their long-term experience with combined-modality, conservative treatment in patients with muscle-invasive bladder cancer. METHODS: In total, 121 patients with T2, T3, or T4 bladder cancer (mean age, 63 years; ratio of men to women, 3:1) underwent induction by transurethral resection (TUR) of the tumor and received 2 cycles of neoadjuvant chemotherapy followed by radiotherapy (RT) (n = 43 patients) or radiochemotherapy (RCT) (n = 78 patients). Six weeks after RT or RCT, responses were evaluated by restaging TUR. Patients who achieved a complete response (CR) were observed at regular intervals. In patients who had persistent or recurrent invasive tumor, further treatment was recommended. RESULTS: Local response evaluation by restaging TUR was possible in 119 patients, and 102 of those patients (85.7%) achieved a CR. After a median follow-up of 66 months (range, 6-182 months), no local or distant disease recurrences were observed in 67 of 102 complete responders (65.7%), 17 of 102 complete responders (16.7%) experienced superficial local disease recurrence, and 18 of 102 complete responders (17.6%) had a muscle-invasive relapse. The 5-year tumor-specific, overall, and bladder-intact survival rates were 73.5%, 67.7%, and 51.2%, respectively. Treatment modality, tumor classification, and resection status after initial TUR had an impact on survival rates (P = .04, P = .02, and P = .02, respectively). CONCLUSIONS: The current results indicated that conservative combined treatment is a reasonable alternative to radical cystectomy in selected patients with muscle-invasive bladder cancer.     

Independent predictors of cancer-specific survival in transitional cell carcinoma of the upper urinary tract: multi-institutional dataset from 3 European centers

BACKGROUND: The objective of the current study was to identify variables that were predictive of cancer-specific survival in patients with nonmetastatic transitional cell carcinoma of the upper urinary tract (UUT-TCC). METHODS: Clinical and pathologic data from 269 patients who underwent nephroureterectomy for UUT-TCC from 1989 to 2005 in 3 urologic European centers were collected retrospectively. Log-rank tests and Cox proportional-hazards regression models were used for univariate and multivariate analyses. RESULTS: Two hundred fifty patients underwent nephroureterectomy, and 19 patients underwent concomitant cystectomy for synchronous muscle-invasive bladder cancer. The median follow-up of the whole cohort was 34 months, and the median follow-up of the patients who remained alive and disease-free was 52 months. At follow-up, 57 cancer-related deaths (21.2%) were censored, and 169 patients (62.8%) were alive and disease-free. On univariate analysis, a history of previous bladder cancer, pathologic stage of the primary tumor and lymph nodes, tumor grade, the presence of lymphovascular invasion, tumor site, synchronous muscle-invasive bladder TCC, and tumor multifocality were associated with cancer-specific survival probabilities. On multivariate analysis, pathologic stage of the primary tumor and lymph nodes, tumor multifocality within the UUT, synchronous muscle-invasive bladder TCC, and a history of bladder TCC before the diagnosis of UUT-TCC were independent predictors of cancer-specific survival probabilities. CONCLUSIONS: In a multi-institutional dataset of patients who had undergone nephroureterectomy for UUT-TCC, the current results indicated that pathologic stage of the primary tumor and lymph nodes, a history of prior bladder TCC, the presence of synchronous muscle-invasive bladder cancer, and tumor multifocality within the UUT were independent predictors of cancer-specific survival probabilities.