Comparison of therapeutic effects between early and delayed cystectomy on high-risk nonmuscle invasive bladder cancer
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摘要: 目的：通过高危非肌层浸润性膀胱癌患者早期与延迟行膀胱全切术的疗效比较，探讨高危非肌层浸润性膀胱癌患者的适用治疗方法。方法：回顾性分析2000年1月~2008年12月我院收治的70例非肌层浸润性膀胱癌患者的临床资料：均首次行TURBT联合卡介苗（BCG）治疗，术后均复发，再行膀胱全切术。根据肿瘤复发情况及再手术时间，分为早期膀胱全切组28例，延迟膀胱全切组42例。结果：早期膀胱全切组中，5例死亡，其中3例死亡原因与肿瘤相关，2例死于心脑血管等其他疾病；延迟膀胱全切组中，9例死亡，其中5例死亡原因与肿瘤相关，1例死于意外伤，3例死于心脑血管等其他疾病。早期全切组5年总体生存率为82.1%，延迟全切组为79.6%，两组差异无统计学意义（P=0.803）。早期全切组5年肿瘤特异性生存率为90.9%，延迟全切组为75.0%，两组差异无统计学意义（P=0.125）。延迟全切组较早期全切组患者生活质量满意程度高，其中生理得分延迟与早期全切组分别为87.94分和58.95分，心理得分延迟与早期全切组分别为93.08分和70.12分，社会关系得分延迟与早期全切组分别为85.82分和60.67分。以上各项得分差异均有统计学意义（P<0.05）。环境因素得分延迟与早期全切组分别为83.51分和91.18分，差异无统计学意义（P>0.05）。结论：对高危非肌层浸润性膀胱癌患者尽可能行TURBT联合BCG灌注治疗，确保患者的生活质量，直到肿瘤出现进展或浸润时再行膀胱全切术。Abstract: Objective: To explore the accessible treatment of the patients with high-risk nonmuscle invasive bladder cancer through the comparison of curative effect between early cystectomy and delayed cystectomy. Method: A retrospective analysis of clinical data of 70 cases of high-risk nonmuscle invasive bladder cancer, who were admitted in our hospital from January 2000 to December 2008 was made. They all accepted TURBT combined with BCG. According to the situation of tumor recurrence and the time of reoperation, we divided them into two groups:28 patients underwent early cystectomy and 42 patients underwent delayed cystectomy.Result: In early cystectomy group, five patients died (three cases of death associated with cancers, the other two cases of death associated with cardiovascular diseases), and in delayed cystectomy group, nine patients died (five cases of death associated with cancers, one case of death associated with accidental trauma, three cases of death associated with cardiovascular diseases). The five-year total survival rate for the early cystectomy group and the delayed cystectomy group were 82.1% and 79.6%, respectively, and there was no significant statistical difference between the two groups (P=0.803). The five-year tumor-specific survival rate for the early cystectomy group and the delayed cystectomy group were 90.9% and 75.0%, respectively, and there was no significant statistical difference between the two groups (P=0.125). The delayed cystectomy group had higher degree of satisfaction about quality of life than the early cystectomy group. The physiological score of the delayed cystectomy group and the early cystectomy group were 87.94 points, 58.95 points respectively, and the psychological score of the former and the latter were 93.08 points, 70.12 points respectively. Moreover, the social relationship score of the delayed cystecto-my group and the early cystectomy group were 85.82 points, 60.67 points, and there were significant differences between the two groups of all of the above scores (P<0.05). The environmental score of the delayed cystectomy group and the early cystectomy group were 83.51 points, 91.18 points respectively, there was no significant difference (P>0.05).Conclusion: It is suggested that the patients with high risk of nonmuscle invasive bladder cancer should be treated with TURBT and BCG and make sure the patient's quality of life. Total cystectomy won't be taken until bladder tumors progress into an invasive stage.
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Key words:
- bladder cancer /
- total cystectomy /
- high-risk patient
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