摘要
目的:探讨膀胱肉瘤样癌的诊断和治疗方法,以提高这种特殊疾病患者的临床管理水平和治疗效果。方法:回顾性分析2010年2月—2021年1月徐州市中心医院收治的5例膀胱原发性肉瘤样癌患者的临床资料。患者均为男性,中位年龄78岁。4例行腹腔镜下膀胱癌根治术,1例行膀胱部分切除术。全切患者中1例术前、术后行吉西他滨+奈达铂静脉化疗,部分切患者术后行吉西他滨膀胱灌注。结果:5例患者术后病理均确诊为膀胱肉瘤样癌。术后随访6~37个月,4例死亡,1例存活;其中2例发生术后淋巴结或肠转移。全切患者中,2例为T1N0M0,1例为T2N0M0,1例为T3N0M0。膀胱部分切患者为T2N0M0。免疫组化显示波形蛋白(Vim)及细胞角蛋白(CK)均为阳性。结论:膀胱肉瘤样癌是在临床实践中遇到的一种相对罕见的情况,其临床表现类似于典型的尿上皮癌。诊断困难,且大多数病例在最初发现时有肌层浸润,恶性程度高,有复发和转移的倾向,预后不良。手术干预是肉瘤样癌的主要治疗方法,通过术后化疗和其他辅助措施,有改善患者生存期的潜力。
Objective: To examine the diagnostic and therapeutic approaches utilized for sarcomatoid carcinoma of the bladder, with the aim of enhancing the clinical management and treatment outcomes for patients afflicted with this particular disease. Methods: The clinical data of 5 patients with primary sarcomatoid carcinoma of the bladder admitted to Xuzhou Central Hospital from February 2010 to January 2021 were retrospectively analyzed. The patients were all male, with an average age of 78 years old. Four cases underwent laparoscopic radical cystectomy for bladder cancer and 1 case underwent partial cystectomy. One of the total resection patients underwent preoperative and postoperative gemcitabine + nedaplatin intravenous chemotherapy, and the partial resection patient underwent postoperative gemcitabine bladder instillation. Results: Postoperative pathology confirmed the diagnosis of sarcomatoid carcinoma of the bladder in all 5 patients. After 6-37 months of postoperative follow-up, 4 cases died and 1 case survived. Two of them developed postoperative lymph node or intestinal metastases. Among the patients with total resection, there were 2 cases of stage T1N0M0, 1 case of stage T2N0M0,1 case of stage T3N0M0, and the patient with partial cystotomy was staged as T2N0M0. Immunohistochemistry showed that both Vim and CK were positive.Conclusion: Sarcomatoid carcinoma of the bladder is an infrequent occurrence in clinical practice, sharing clinical manifestations akin to typical uroepithelial carcinoma. Its diagnosis poses challenges, and the majority of cases exhibit an unfavorable prognosis due to early detection being hindered by muscular infiltration, a high level of malignancy, and a tendency for recurrence and metastasis. Surgical intervention serves as the primary treatment modality for sarcomatoid carcinoma, offering the potential to enhance patient survival rates when combined with postoperative chemotherapy and other supplementary approaches.
作者
王鑫磊
陈俊志
刘欣宇
刘形
梁清
董秉政
臧光辉
史振铎
韩从辉
WANG Xinlei;CHEN Junzhi;LIU Xinyu;LIU Xing;LIANG Qing;DONG Bingzheng;ZANG Guanghui;SHI Zhenduo;HAN Conghui(Xuzhou Clinical School of Xuzhou Medical University,Xuzhou,Jiangsu,221000,China;Department of Urology,Xuzhou Central Hospital)
出处
《临床泌尿外科杂志》
CAS
2024年第3期242-245,共4页
Journal of Clinical Urology
基金
国家自然科学基金(No:12271467)
江苏省科技重点项目(No:BE2020758)
徐州市重点研发项目(No:KC19075)。
关键词
肉瘤样癌
膀胱癌
诊断
治疗
sarcomatoid carcinoma
bladder cancer
diagnosis
treatment
