年轻膀胱癌患者50例临床及病理特征分析
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摘要
目的通过分析30岁以下年轻膀胱癌患者的临床资料,探讨其临床特征及诊治措施。方法回顾性分析50例30岁以下膀胱癌患者的临床资料,并获取患者随访信息。结果所有患者术后病理回报均为尿路上皮癌。非浸润性尿路上皮癌患者共44例(88%)均行TURBT手术治疗。10例(20%)为低度恶性潜能尿路上皮乳头状瘤,至随访结束均存活且无复发;27例(54%)为低级别尿路上皮癌,其中17例(34%)存活无复发;7例(14%)为高级别尿路上皮癌,其中2例(4%)存活无复发,3例(6%)局部复发,2例(4%)侵及肌层。而浸润性尿路上皮癌共6例(12%),其中侵及肌层5例(浅肌层4例,3例死亡,深肌层1例,仍存活),侵及膀胱周围组织1例,于术后16个月死亡。结论年轻人膀胱癌(30岁以下)缺乏典型的临床表现,是一类少见的、侵袭性较弱,组织分级较低,预后较好的尿路上皮肿瘤。诊断主要依靠病理学和免疫组织化学方法,膀胱镜与泌尿系超声可以作为辅助诊断手段。非肌层浸润性尿路上皮癌患者首次均行经尿道膀胱肿瘤电切术治疗,术后均行规律膀胱灌注化疗,并定期复查膀胱镜;肌层浸润性尿路上皮癌患者可根据肿瘤的大小、位置、浸润深度,行膀胱部分切除或者根治性膀胱全切术。
Objective To analyze the clinical features,diagnosis and treatment of young bladder cancer patients under 30 years old.Methods The clinical data of 50 bladder cancer patients under 30 years old were retrospectively analyzed.The follow-up information was obtained.Results All cases were urothelial carcinoma.Of all cases,44(88%)were non-invasive urothelial carcinoma treated with transurethral bladder tumor resection(TURBT),and 6(12%)were invasive,including 5 myoinvasion(4 superficial myoinvasion and 3 died,1 deep myoinvasion and still surviving),and 1 perivesical invasion which died 16 months after surgery.The grades of the cases:10(20%)were low-grade malignant urothelial carcinoma and survived without recurrence;27(54%)were low-grade urothelial carcinoma,17(34%)of which survived without recurrence;7(14%)were highgrade urothelial carcinoma,including 2(4%)which survived without recurrence,3(6%)which had local recurrence,and2(4%)which were myometrial invasive.Conclusions Young bladder carcinoma(under 30 years old)is a rare type of urothelial carcinoma with atypical clinical manifestations,weak invasiveness,low tissue grade,and good prognosis.The diagnosis relies mainly on pathology and immunohistochemistry.Cystoscopy and urinary ultrasound can be used as auxiliary diagnostic tools.Patients with non-muscle invasive urothelial carcinoma can be treated with TURBT,followed by regular intravesical chemotherapy and cystoscopy reexamination.For myometrial invasive urothelial carcinoma,partial cystectomy or radical cystectomy can be adopted depending on the size,location,and depth of invasion of the tumor.
Objective To analyze the clinical features,diagnosis and treatment of young bladder cancer patients under 30 years old.Methods The clinical data of 50 bladder cancer patients under 30 years old were retrospectively analyzed.The follow-up information was obtained.Results All cases were urothelial carcinoma.Of all cases,44(88%)were non-invasive urothelial carcinoma treated with transurethral bladder tumor resection(TURBT),and 6(12%)were invasive,including 5 myoinvasion(4 superficial myoinvasion and 3 died,1 deep myoinvasion and still surviving),and 1 perivesical invasion which died 16 months after surgery.The grades of the cases:10(20%)were low-grade malignant urothelial carcinoma and survived without recurrence;27(54%)were low-grade urothelial carcinoma,17(34%)of which survived without recurrence;7(14%)were highgrade urothelial carcinoma,including 2(4%)which survived without recurrence,3(6%)which had local recurrence,and2(4%)which were myometrial invasive.Conclusions Young bladder carcinoma(under 30 years old)is a rare type of urothelial carcinoma with atypical clinical manifestations,weak invasiveness,low tissue grade,and good prognosis.The diagnosis relies mainly on pathology and immunohistochemistry.Cystoscopy and urinary ultrasound can be used as auxiliary diagnostic tools.Patients with non-muscle invasive urothelial carcinoma can be treated with TURBT,followed by regular intravesical chemotherapy and cystoscopy reexamination.For myometrial invasive urothelial carcinoma,partial cystectomy or radical cystectomy can be adopted depending on the size,location,and depth of invasion of the tumor.
引文
[1]韩苏军,张思维,陈万青,等.中国膀胱癌发病现状及流行趋势分析[J].癌症进展,2013(01):89-95.
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[5]ALANEE S,SHUKLA AR.Bladder malignancies in children aged<18years:results from the surveillance,epidemiology and end results database[J].BJU Int,2010,106(4):557-560.
[6]TELLI O,SARICI H,OZGUR BC,et al.Urothelial cancer of bladder in young versus older adults:clinical and pathological characteristics and outcomes[J].Kaohsiung J Med Sci,2014,30(9):466-470.
[7]WEN YC,KUO JY,CHEN KK,et al.Urothelial carcinoma of the urinary bladder in young adults--clinical experience at Taipei Veterans General Hospital[J].J Chin Med Assoc,2005,68(6):272-275.
[8]FINE SW,HUMPHREY PA,DEHNER LP,et al.Urothelial neoplasms in patients 20years or younger:a clinicopathological analysis using the world health organization 2004bladder consensus classification[J].J Urol,2005,174(5):1976-1980.
[9]YOSSEPOWITCHO,DALBAGNI G.Transitional cell carcinoma of the bladder in young adults:presentation,natural history and outcome[J].J Urol,2002,168(1):61-66.
[10]FITZPATRICK JM,REDA M.Bladder carcinoma in patients 40years old or less[J].J Urol,1986,135(1):53-54.
[11]KURZ KR,PITTS WR,VAUGHAN EJ.The natural history of patients less than 40years old with bladder tumors[J].J Urol,1987,137(3):395-397.
[12]KESSLER TM,BURKHARD FC,STUDER UE.Clinical indications and outcomes with nerve-sparing cystectomy in patients with bladder cancer[J].Urol Clin North Am,2005,32(2):165-175.
[13]朱连珠.健康教育对年轻膀胱癌患者焦虑抑郁状态及生活质量的影响[J].中国现代医生,2012,50(29):118-120.
[14]PLOUSSARD G,DANESHMAND S,EFSTATHIOU JA,et al.Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer:a systematic review[J].Eur Urol,2014,66(1):120-137.
[15]白云金,杨玉帛,王晓明,等.肌层浸润性膀胱癌保留膀胱治疗研究进展[J].现代泌尿外科杂志,2017,22(2):149-151.
[2]PANER GP,ZEHNDER P,AMIN AM,et al.Urothelial neoplasms of the urinary bladder occurring in young adult and pediatric patients:a comprehensive review of literature with implications for patient management[J].Adv Anat Pathol,2011,18(1):79-89.
[3]STANTON ML,XIAO L,CZERNIKA BA,et al.Urothelial tumors of the urinary bladder in young patients:a clinicopathologic study of 59cases[J].Arch Pathol Lab Med,2013,137(10):1337-1341.
[4]SAMARATUNGA H,MAKAROV DV,EPSTTEIN JI.Comparison of WHO/ISUP and WHO classification of noninvasive papillary urothelial neoplasms for risk of progression[J].Urology,2002,60(2):315-319.
[5]ALANEE S,SHUKLA AR.Bladder malignancies in children aged<18years:results from the surveillance,epidemiology and end results database[J].BJU Int,2010,106(4):557-560.
[6]TELLI O,SARICI H,OZGUR BC,et al.Urothelial cancer of bladder in young versus older adults:clinical and pathological characteristics and outcomes[J].Kaohsiung J Med Sci,2014,30(9):466-470.
[7]WEN YC,KUO JY,CHEN KK,et al.Urothelial carcinoma of the urinary bladder in young adults--clinical experience at Taipei Veterans General Hospital[J].J Chin Med Assoc,2005,68(6):272-275.
[8]FINE SW,HUMPHREY PA,DEHNER LP,et al.Urothelial neoplasms in patients 20years or younger:a clinicopathological analysis using the world health organization 2004bladder consensus classification[J].J Urol,2005,174(5):1976-1980.
[9]YOSSEPOWITCHO,DALBAGNI G.Transitional cell carcinoma of the bladder in young adults:presentation,natural history and outcome[J].J Urol,2002,168(1):61-66.
[10]FITZPATRICK JM,REDA M.Bladder carcinoma in patients 40years old or less[J].J Urol,1986,135(1):53-54.
[11]KURZ KR,PITTS WR,VAUGHAN EJ.The natural history of patients less than 40years old with bladder tumors[J].J Urol,1987,137(3):395-397.
[12]KESSLER TM,BURKHARD FC,STUDER UE.Clinical indications and outcomes with nerve-sparing cystectomy in patients with bladder cancer[J].Urol Clin North Am,2005,32(2):165-175.
[13]朱连珠.健康教育对年轻膀胱癌患者焦虑抑郁状态及生活质量的影响[J].中国现代医生,2012,50(29):118-120.
[14]PLOUSSARD G,DANESHMAND S,EFSTATHIOU JA,et al.Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer:a systematic review[J].Eur Urol,2014,66(1):120-137.
[15]白云金,杨玉帛,王晓明,等.肌层浸润性膀胱癌保留膀胱治疗研究进展[J].现代泌尿外科杂志,2017,22(2):149-151.