摘要
目的：初步探讨手术联合GC（吉西他滨和顺铂）方案治疗混合型膀胱小细胞癌的治疗效果及预后。方法：回顾性分析南京大学医学院附属鼓楼医院自2012年5月-2014年3月收治的7例混合型膀胱小细胞癌患者的临床资料。其中男6例,女1例。年龄49-71岁,中位年龄61岁。7例患者均有不同程度血尿症状,5例患者伴发尿路刺激征。所有患者术前均行B超及泌尿系CTU扫描以明确膀胱内肿瘤,4例患者行膀胱癌根治性切除术,3例行经尿道膀胱肿瘤电切术。结果：所有患者术后病理均证实为混合型膀胱小细胞癌,免疫组织化学染色为：Syn、CgA、CD56、Ki-67均为中等-强阳性表现,uroplakin散在阳性。其中,5例为小细胞癌混合高级别浸润性尿路上皮癌,2例混合低级别尿路上皮癌。7例患者术后1个月按计划行4-6个周期的GC方案化疗,但2例患者因化疗反应过大,未完成预定化疗方案,余5例患者均顺利完成化疗。7例患者均获得随访资料,中位生存时间为19个月,除1例患者术后因疾病进展死于肿瘤转移外,其余患者均存活。结论：混合型膀胱小细胞癌恶性程度高,预后不良,确诊依赖病理学及免疫组织学检查。早期采用手术切除仍是首选治疗方式,但配合化疗等治疗可提高术后疗效。但本组病例数较少,且缺乏相关临床对照试验,其远期预后及疗效仍需长期随访观察。
Objective： To initially investigate the clinical efficacy and prognosis of surgery combined with GC （gemcitabine and eisplatin） regimen for the bladder small cell carcinoma （BSCC） mixed with other kinds of bladder cell carcinoma. Method： From May 2012 to March 2014, seven patients including six males and one female were treated for the mixed BSCC, and their clinical data were reviewed. The average age was 61 （range, 49-71） years. All patients had different degrees of symptom of hematuresis, and five of them also had irritation signs of bladder. The tumor of bladder were confirmed by B ultrasound or CTU scan in all patients before surgery. Four cases were operated with radical cystectomy, and the rest three cases underwent transurethral resection of bladder tumor. Result： The postoperative pathology showed that all cases were mixed BSCC. Five patients were found blended with high level of invasive urothelial carcinoma, and the other two patients were blended with low level of urothelial carcinoma. The immunohistochemieal staining showed that Syn, CgA, CD56, Ki-67 were stronger positive in all cases, while uroplakin was found scattered positive expression in the samples. Patients were all treated with 4-6 cycles of GC regimen after a month of operation. Only two cases didn＇t accomplish chemotherapy because of insufferable side effects. The follow-up data were availabe in all cases, and the median survival time was 19 months. All patients survived except that one case died of tumor progression and metastasis. Conclusion： The mixed BSCC shows poor prognosis because of high-grade malignancy. A confirmed diagnosis depends on pathology and immunohistological examination. Surgical resection is still the preferred treatment in the early stage, and postoperative adjuvant chemotherapy may improve the effect. However, the number of case and relevant clinical controlled trials are so little that a long-term follow-up is still needed in order to evaluate the prognosis and curative effect.
出处
《临床泌尿外科杂志》
2015年第12期1073-1076,共4页
Journal of Clinical Urology
