TURBT术治疗T1T2期膀胱癌91例

目的:分析两种手术方法对T1T2期膀胱癌的治疗效果。方法:根据病史、体格检查、B超、3D-CT、膀胱镜活组织检查确诊的T1T2期膀胱癌152例,采用TURBT术(经尿道膀胱肿瘤切除术)91例,膀胱局部切除术61例,分析比较治疗效果。结果:两种手术方法疗效无显著特异性,患者生存率与肿瘤病理分期有直接相关性。结论:T1T2期膀胱癌采用TURBT术与采用膀胱局部切除术疗效相当,但TURBT费用低,创伤少,便于再次手术,有推广意义。     

Expression of PDZ-binding kinase/T-LAK cell-originated protein kinase (PBK/TOPK) in human urinary bladder transitional cell carcinoma

The objective of this study was to evaluate the expression pattern of PDZ-binding kinase/T-LAK cell-originated protein kinase (PBK/TOPK) and its clinical significance in human bladder cancer (BC).     

经尿道电切联合丝裂霉素膀胱内灌注治疗非肌层浸润性膀胱癌

目的探讨经尿道电切术（transurethral reseetion of bladder tumor,TURBT）及术后使用丝裂霉素C（mitomycin C,MMC）膀胱内灌注治疗非肌层浸润性膀胱癌的临床疗效。方法本组46例非肌层浸润性膀胱癌均采用TURBT,术后使用MMC膀胱内灌注治疗。结果所有病例均一次完整切除。随访2年,37例非肌层浸润性膀胱癌无复发,7例分别于1年内复发,2例2年内复发。复发病例均再行TURBT并继续MMC膀胱内灌注。结论TURBT治疗非肌层浸润性膀胱癌具有手术简单、损伤小、出血少、恢复快和疗效好等优点。MMC膀胱内灌注能明显减少非肌层浸润性膀胱癌的复发。     

Relook TURBT in superficial bladder cancer: its importance and its correlation with the tumor ploidy

ObjectiveTo evaluate various prognostic factor predictors of residual growth in Relook transurethral resection of bladder tumor (TURBT) in superficial bladder cancer. Also, to evaluate the role of Relook TURBT along with the ploidy for prediction of recurrence and stage progression in these patients.Material and MethodsFifty patients with superficial bladder cancer underwent TURBT after complete evaluation. Ploidy of the tumor specimen was evaluated by flow cytometry. After 4 to 6 weeks of initial TURBT, these patients underwent Relook TURBT. Final treatment was given after the results of the histological evaluation of these specimens. Patients who underwent bladder sparing treatment were followed-up.ResultsOf the patients, 28.5% had residual tumor in Relook TURBT. Growth was found to be at the same site in 66.7% and at a different site 33.3%; 75% had single while 25% had multiple residual growth. Residual malignant tissue had a statistically significant correlation with size of the tumor (>3 cm), appearance (solid tumor), number (>3), grade (high), and multiple previous resections. Overall, the up-migration of stage and grade leads to change in treatment in 41.6%; 5 underwent radical cystectomy and 1 opted for radiotherapy; in 2 patients, intravesical BCG was given. In follow-up of mean 11.5 months, 16.6% had recurrence. Presence of residual growth in Relook TURBT along with number, size, morphology, and multiple previous resections were found to have significant correlation with the recurrence in these patients. Ploidy and grade of the tumor were not found to have correlation.ConclusionsMultiple, more than 3 cm, solid high grade tumor with > 3 previous resections were predictors of presence of residual tumor in Relook TURBT. Presence of residual growth is a significant risk factor for recurrence. Ploidy was not found to be significantly correlated with recurrence.     

TURBT术后序贯放化疗治疗对老年 MIBC 患者生存时间及生活质量的影响

目的:探讨经尿道膀胱肿瘤电切术（transurethral resection of bladder tumor,TURBT）术后序贯放化疗治疗对老年肌层浸润性膀胱癌（muscular invasive bladder cancer,MIBC）患者生存时间及生活质量的影响。方法:回顾性分析我院2012年03月至2016年12月收治老年MIBC患者共68例临床资料,其中38例采用膀胱根治切除方案设为对照组,30例采用TURBT术后序贯放化疗方案设为观察组;比较两组总生存时间、肿瘤特异性生存时间及手术前后QOL评分。结果:入选患者随访14~58个月,中位随访时间为37.0个月;其中观察组总生存率和肿瘤特异性生存率分别为66.67%（20/30）,80.00%（24/30）;对照组总生存率和肿瘤特异性生存率分别为65.79%（25/38）,81.58%（31/38）;两组总生存率和肿瘤特异性生存率比较差异无统计学意义（P＞0.05）;两组术后6个月QOL评分显著低于术前（P＜0.05）;但观察组术后6个月QOL评分显著高于对照组（P＜0.05）。结论:老年MIBC患者采用TURBT术后序贯放化疗方案可获得与膀胱根治切除方案相近的生存获益,且术后生活质量显著改善。     

首次经尿道膀胱肿瘤切除术的诊断价值及其影响因素探讨

目的探讨首次经尿道膀胱肿瘤切除术（TURBT）的诊断价值及其相关影响因素。方法回顾分析112例初步诊断为非肌层侵润性膀胱癌患者的临床资料,首次TURBT切除肿瘤并确定病理结果,与术后2—6周二次电切术（93例）、部分切除术（9例）和根治切除术（10例）病理结果进行比较。结果首次TURBT切除标本组织形态人为改变23例（20．54％）,标本组织肌层缺失35例（31．25％）。比较发现,首次TURBT后肿瘤残余47例（41．96％）,病理结果一致84例（75．oo％）,病理被低估28例（25．00％）。肿瘤进展风险、肿瘤位置、电切方法和术者经验与首次TURBT肿瘤残余有关（P〈0．05）;Logistic分析得出影响首次TURBT肿瘤残余的因素依次为：肿瘤进展风险〉电切方法〉术者经验〉肿瘤位置;电切方法、术者经验与标本组织肌层缺失有关（P〈0．05）;电切设备与标本组织形态改变有关（P〈0．05）;标本肌层缺失、标本组织形态改变与首次TURBT病理结果正确率有关（P〈0．05）。结论首次TURBT存在肿瘤残余、病理低估等缺陷,主要原因是无法保证高质量的TURBT并留取符合要求的标本,提倡有经验的医师通过双极等离子电刀系统来进行诊断性TURBT,对于高危膀胱肿瘤二次TURBT是有必要的。     

Does the presence of muscularis propria on transurethral resection of bladder tumour specimens affect the rate of upstaging in cT1 bladder cancer?

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? It is already known and accepted that the presence of mucularis propria (MP) on bladder biopsy is incremental to the clinical staging process for this disease entity. This study establishes that the lack of MP also portends a higher risk of pathologic upstaging at the time of radical cystectomy. OBJECTIVE

• ? To determine how the presence of MP on T1 biopsy specimens affects the outcome of patients undergoing RC as compared to when no MP is identified in the TURBT specimen.

PATIENTS AND METHODS

• ? Patients were retrospectively identified from the Columbia University Urologic Oncology Database.
• ? From January 1986 to October 2009, 114 patients diagnosed with cT1N0M0 bladder cancer who underwent RC within 4 months of their last biopsy were identified.
• ? Patients were stratified based on the presence of MP on T1 biopsy, and upstaging was defined as any tumor T2 or greater, N+, or M+ at the time of radical cystectomy.
• ? The rate of upstaging was assessed using univariate and multivariate regression models; Kaplan meier curves were also extrapolated for each cohort to compare disease specific and overall survival patterns.

RESULTS

• ? Of the 114 patients evaluated in this study, 24 (20.2%) did not have MP on their T1 biopsy before RC. The rate of upstaging (>=pT2) stratified by the presence of MP on biopsy was 50% and 78%, respectively (p = 0.017).
• ? On univariate analysis, lack of MP on biopsy was associated with an increased risk of upstaging (HR 3.52, p = 0.021, CI 1.2–10.3), however did not reach significance as an independent predictor (HR 2.9, p = 0.056, CI 0.97–8.9).
• ? At a mean follow‐up of 33.5 months, there was no difference in disease specific (p = 0.41) and overall survival (p = 0.68) between groups.

CONCLUSIONS

• ? The lack of MP on TURBT for high grade cT1N0M0 bladder cancer portends a high likelihood of upstaging at RC, although this risk did not translate into a detectable increased risk of disease specific mortality.

     

同期行经尿道电切术治疗膀胱癌并前列腺增生33例临床分析

目的:探讨同期施行经尿道膀胱肿瘤及前列腺电切术的治疗效果。方法:回顾性分析33例膀胱肿瘤并前列腺增生患者同期经尿道电切术的临床资料。随访6~40个月。结果:术后复发3例,复发时间为术后12~18个月,未见前列腺窝有种植转移。结论:膀胱肿瘤并前列腺增生可同期行经尿道电切术。