Recurrence and Progression of Stage T1, Grade 3 Transitional Cell Carcinoma of the Bladder Following Transurethral Resection Plus Intravesical Chemotherapy

對於 Stage T1G3 膀胱移形上皮細胞癌術後復發率及疾病進展的分析

張進寶(Chin-Pao Chang) ； 黃勝賢(Sheng-Hsien Huang) ； 戴慧龍(Hui-Lung Tai) ； 王百孚(Bai-Fu Wang) ； 嚴孟意(Meng-Yi Yen) ； 黃國軒(Kuo-Hsuan Huang) ； 江恒杰(Herng-Jye Jiang) ； 林介山(Jesun Lin)

《臺灣泌尿科醫學會雜誌》 14卷4期 (2003/12) Pp. 176-182

摘要

研究目的：本篇研究報告是想要探討早期且分化不良細胞（T1G3）膀胱癌的病患接受經尿道膀胱腫瘤切除手術合併膀胱藥物灌洗後，其復發率及疾病進展的評估分析。
材料與方法：從1991年1月至2000年12月總共有212位早期膀胱移形上皮細胞癌的病患（Ta 至 T1 期，細胞分化等級 1 至3），在本院接受經尿道膀胱腫瘤切除手術，其中有40位（佔18.9％）病患是屬於 T1 期且分化不良的細胞，年齡分佈從36至90歲不等，平均年齡為69.3歲，男與女比率為3比1，所有病患經尿道膀胱腫瘤切除手術後都接受膀胱藥物灌洗，其中9人接受 BCG 灌洗，另31人接受非 BCG 藥物灌洗，追蹤期間從12至100個月不等，其中有3位病患失去追蹤。
結果：40位病患中有14位（佔37.8％）發生腫瘤復發，在接受手術後，平均復發時間為6.8個月（從3至12個月不等），另外有5位（佔13.5％）產生疾病進展，其中包括3位侵犯至肌肉層，1位侵犯至輸尿管及肌肉層，1位有骨頭轉移，有4位病患於追蹤10至44個月後死亡，6位病患死於非相關之疾病。
結論：針對T1期且分化不良的膀胱癌患者在接受經尿道腫瘤切除手術後再給予膀胱內免疫或化學藥物灌洗的輔助治療是有效的治療方式，從本院的研究分析證實此種治療方式是第一線的優先選擇，立即施行根除性膀胱切除手術是不需要的。

關鍵字

T1期 ； 分化不良細胞 ； 膀胱移形上皮細胞癌

並列摘要

OBJECTIVE: This retrospective study evaluates the incidence of recurrence and progression in patients with T1G3 bladder cancer treated by transurethral resection of the bladder tumor (TUR-BT) and intravesical instillation.
MATERIALS AND METHODS: From January 1991 to December 2000, 212 patients underwent transurethral resection for superficial transitional cell carcinoma (TCC) of the bladder. The disease was stage T1 grade 3 in 40 patients (18.9%). Their ages ranged from 36 to 90 with a mean of 69.3 years, and the male to female ratio was 3:1. All of the patients received intravesical immunotherapy or chemotherapy following TUR-BT. Of these 40 patients, 9 cases received bacillus Calmette-Guerin (BCG) and 31 cases received non-BGG instillation. The follow-up period ranged from 12 to 100 months, and 3 patients were lost to follow-up.
RESULTS: Of 40 patients, 14 (37.8%) developed recurrence in the urinary bladder. The median interval to recurrence was 6.8 (range, 3-12) months after the initial TUR-BT. Five (13.5%) patients developed disease progression, including 3 patients with muscle invasion, 1 patient with muscle and ureter invasion, and 1 patient with bone metastasis. Four patients died of the disease at 10 to 44 months. And 6 patients died of unrelated disease.
CONCLUSIONS: Adjuvant intravesical immunotherapy or chemotherapy constitutes an effective primary treatment for T1 G3 bladder cancer following complete resection of the tumor. Our series confirms the validity of first-line treatment with TUR-BT and intravesical instillation for T1 G3 bladder tumors.

並列關鍵字

transitional cell carcinoma ； bacillus Calmette-Guerin