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中華民國泌尿科醫學會雜誌

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篇名 Recurrence and Progression of Stage T1 superficial Bladder Cancer
卷期 9:1
並列篇名 表淺性膀胱癌第一期之復發性及侵犯性
作者 林嘉祥楊啟瑞歐宴泉高育琳程千里
頁次 1-6
關鍵字 表淺性膀胱癌移形細胞癌膀胱內化學灌注復發侵犯superficial bladder cancertransitional cell carcinomaintravesical chemotherapyrecurrenceprogressionTSCI
出刊日期 199803

中文摘要

從1982年10月至1996年3月,總數86位表淺性膀胱癌第一期病人於本院接受經尿道切除腫瘤及輔助性膀胱內化學治療。原位癌已經在文獻上被證實為\疾病復發及侵犯的高危險因子,因此被排除在本研究之外。平均年齡為63.9歲(38~84),平均追蹤時間為60.2個月(13~163)。所有的病人皆在全身麻醉下接受骨盆腔兩手式的檢查。膀光癌標本則根據不同的深度分次切除。細胞分化等級依據UECC-3分類系統判定。輔助性膀胱內化學治療則選擇性在高危險群實施。86位病人根據腫瘤細胞分化等級是否接受膀胱內化學灌注治療分為四組:第一組T1G2無膀胱內化學灌注治療22人,第二組T1G2有膀胱內化學灌注治療16人,第三組T1G3無膀胱內化學灌注治療18人,第四組T1G3有膀胱內化學灌注治療30人。四組平均復發率分別為72.7%,75%,83.3%及83.3%。第一期膀胱癌概括復發率為80.2%,概括侵犯率為22.1%,T1G2疾病相對T1G3疾病的侵犯率為2.8%相對37.5%(p<0.001),膀胱內化學治療並未能改變此疾病的侵犯性(第三組比第四組:38.9%比36.7%,P=0.878)。T1G2及T1G3疾病為兩種不同的疾病實體,撌統的治療及密切的追蹤對T1G2疾病已經足夠,然而對T1G3疾病而言,則需要更有效的膀胱內免疫治療及精確的預後評估參數。

英文摘要

From October 1982 to March 1996, a total of 86 patients with superficial transitional cell carcinoma of bladder, stage T1, were treated with transurethral resection and adjuvant in-travesical chemotherapy in our hospital. Carcinoma in situ is documented as high risk of recur-rence and progression of disease and was therefore excluded from this study. The mean age was 63.9 years (range 38-84). The mean follow-up period was 60.2 months (range 13-163). Biman-ual exams under general anesthesia were routinely performed. Fractionate resections of various depths were sent. Grading metod was judged by UICC-3 classification system. Adjuvant in-travesical chemotherapy was performed in high risk groups. 86 patients were divided into four groups according to grade and whether they would undergo intravesical instillation (IVI) che-motherapy or not: Group I T1G2 without IVI(22), group II T1G2 with IVI(16), group III T1G3 without IVI(18), and group IV T1G3 with IVI(30). The average recurrence rates were 72.7%, 75%, 83.3% and 83.3% in group I,II,III and IV respectively. The overall recurrence rate of T1 category disease was 80.2%. he overall progresson rate was 22.1%. The progression rate of T1G2 disease versus that of T1G3 disease was 2.8% versus 37.5% (p<0.001). Intravesical che-motherapy did ot alter the progression of the disease (group III vs. group IV: 38.9%vs. 36.7% p=0.878). T1G2 and T1G3 diseases represent two different disease entities. Traditional treat-ment and close follow-up are sufficient for T1G2 disease, but more effective intravesical immu-notherapy and precise prognostic parameters are recommended for T1G3 disease. (J Urol R.O.C., 9:1-6,1998)

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