摘要
目的：提高对原发性膀胱黏液腺癌（包括非脐尿管型和脐尿管型）的诊疗水平,评估预后。方法：回顾分析我院2005年6月~2013年6月收治的18例原发性膀胱黏液腺癌患者,其中非脐尿管型12例,脐尿管型6例。男12例,女6例。平均年龄60（45~78）岁。间歇性、无痛性肉眼血尿为主要就诊症状。手术治疗17例,1例患者全身状况较差未行手术治疗,7例患者术后给予辅助化疗。结果：18例病理报告均为膀胱黏液腺癌,其中脐尿管源性6例。病理分期：T1期3例,T2期8例,T3期5例,T4期1例,未手术患者无病理分期。病理分级：高分化8例、中分化10例。免疫组化：CK7、CK20、EMA、Ki-67、Leu-M1、CEA均＋,Vimentin均-,仅3例PSA＋。17例平均随访17.5（5~68）个月,1例失访。1年生存率58.8%（10/17）,2年生存率40.0%（6/15）,5年生存率33.3%（4/12）。结论：原发性膀胱黏液腺癌少见,造成预后差最重要的因素就是不易早期诊断,根治性膀胱切除术为本病最主要的治疗手段,肿瘤大小对术后生存期有一定影响,术后配合放疗或化疗等综合治疗可延长患者生存期。
Objective：To evaluate the diagnosis and treatment of primary mucinous adenocarcinoma of the bladder（including urachal and non-urachal adenocarcinomas）,and assess prognosis.Method：A retrospective study was taken to analyze the clinical data,treatment options and follow-up results of eighteen cases of primary bladder mucinous carcinoma,including six cases of urachal adenocarcinomas and twelve cases of non-urachal adenocarcinomas.The study included twelve males and six females,with a mean age of 60 years old.The most common clinical symptom was intermittent gross hematuria without pain.Seventeen cases received operation and seven of them received postoperative chemotherapy.One case didn＇t receive operation because of poor general condition.Result：All eighteen cases were pathologically diagnosed as mucinous adenocarcinoma of the bladder,and six of them were urachal adenocarcinoma.Histological staging T1 was seen in three cases,T2 in eight cases,T3 in five cases,T4 in one case.Histological grading was well-differentiated in eight cases,moderately differentiated in ten cases.Immunohistochemically,there were positive reactions for CK7,CK20,EMA,Ki-67,Leu-M1,and CEA,while negative for vimentin,only three cases were positive for PSA.The mean follow-up time was 17.5（5-68）months except one case lost follow up.The 1-year survival rate was 58.8%,2-year survival rate 40.0% and 5-year survival rate 33.3%.Conclusion：Primary mucinous adenocarcinoma of the bladder is rare.The most important factor of its poor prognosis is that early diagnosis is difficult.Radical cystectomy is the main treatment for it,and tumor size has some influence on postoperative survival.Multimodality therapy such as radiotherapy or chemotherapy should be applied to those postoperative patients.
出处
《临床泌尿外科杂志》
2015年第2期112-114,119,共4页
Journal of Clinical Urology
基金
天津市科委重点项目(编号12JCZDJC23700)
天津市科委青年项目(编号14JCQNJC12700)
关键词
膀胱肿瘤
黏液腺癌
根治性膀胱切除术
预后
bladder tumor
mucinous adenocarcinoma
radical cystectomy
prognosis
