目的：回顧和分析我們對肌肉侵入(pT2)性膀胱癌病人治療的經驗，並定義針對個別病人臨床的適當治療策略。材料和方法：從1995年到2000年共有61位病人，男性與女性的比率為43比18，平均年齡為62.4歲（從43到83歲）。我們由病歷回顧病人的治療和臨床經過，包括疾病復發和疾病－特定死亡率。結果：29位病人(48%)病理期別為pT2a膀胱癌，32位病人 (52%) 病理期別為pT2b。31位病人接受單獨的經尿道膀胱腫瘤切除術或加上術後卡介苗灌注治療。21位病人接受單獨的根部切除手術或加上術後輔助性化學放射治療。2位病人接受部份膀胱切除術，而7位病人僅接受化學放射治療（MVAC/CMV或cisplatin/5FU）。於29位pT2a膀胱癌保守療法之病人中有5位病人疾病復發，其中一位因為後期病程之進展而接受了根部切除手術，一位接受部份膀胱切除術，另外三位接受了第二次卡介苗灌注治療。在此pT2a膀胱癌族群中追蹤期間並無病人死於膀胱癌。於32位pT2b膀胱癌保守療法之病人中有5位病人疾病復發，其中二位因為化學放射治療失敗而接受了根部切除手術，一位接受了治療性放射治療，另外二位因全身狀況不佳僅接受姑息治療。結論：對於肌肉侵犯型膀胱癌者，如pT2a-高度分化或pT2b-高度分化二者，在決定是否適合採用膀胱保留治療方式時其腫瘤侵入程度和分化等級是二重要的參數。對於pT2a-低度分化的腫瘤，經尿道膀胱腫瘤切除術加上術後卡介苗灌注治療為第一選擇。而pT2b-高度分化的腫瘤，根部切除手術則為標準治療方式。

OBJECTIVE: To review and analyze our experience in treating patients with muscle-invasive (pT2) bladder cancer and define the proper strategies for individual patients in clinical practice. MATERIALS AND METHODS: Totally, 61 patients were enrolled in this study from 1995 to 2000 with a male-to-female ratio of 43 to 18 and mean age of 62.4 (range, 43~83) years. Each patient's treatment and clinical course, including disease recurrence and disease-specific mortality, were retrospectively reviewed from the charts. RESULTS: Twenty-nine patients (48%) had pathological stage pT2a TCC, and 32 patients (52%) had stage pT2b. Thirty-one patients underwent either transurethral resection of the bladder tumor alone or combined with intravesical bacillus Calmette Guerin (BCG) therapy; 21 patients underwent either radical surgery alone or combined with adjuvant chemoradiotherapy postoperatively; 2 patients received a partial cystectomy; and 7 patients received chemoradiation (MVAC/CMV or cisplatin/5FU). Five 5 patients had recurrent disease after conservative surgery for pT2a TCC leading to a radical cystectomy in I during the latter course of the disease due to progression, a partial cystectomy in 1, and secondary BCG therapy in 3. No patients died of cancer during follow-up in the pT2a group. Among the 32 patients who had pT2b TCC, 5 had recurrence after conservative surgery. Two were converted to radical surgery after failure of the chemoradiation trial, I received therapeutic radiation therapy, and 2 were under conservative treatment due to their poor general condition. CONCLUSIONS: Tumor invasiveness and grading are 2 important parameters to consider in deciding on a bladder-sparing approach for patients with muscle-invasive bladder cancer.