20年膀胱泌尿上皮癌患者接受根除性膀胱切除手術之族群變化
陳冠廷、戴槐青、陳忠信、黃昭淵、王碩盟、蒲永孝、黃國皓
國立台灣大學醫學院附設醫院 泌尿部
Demographic shift in patients underwent radical cystectomy in management of bladder urothelial carcinoma: A 20-year review
Kuan-Ting Chen, Huai-Ching Tai, Chung-Hsin Chen, Chao-Yuan Huang, Shuo-Meng Wang, Yeong-Shiau Pu, Kuo-How Huang
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
Purpose: We present the clinical characteristics and perioperative outcomes of patients with bladder urothelial carcinoma who underwent radical cystectomy at a single tertiary center.
Materials and Methods: We retrospectively enrolled patients with bladder urothelial carcinoma who received radical cystectomy in our hospital from 1995 through 2015. The clinical demographics and oncologic outcomes were collected by reviewing medical records.
Results: A total of 299 patients were analyzed. The median age of these patients is 66-year-old (23-92). There are 56 (19%) patients with T0 disease, 27 (9%) with T1 disease, 60 (20%) with T2 disease, 50 (17%) with T3 disease, 31 (10%) with T4 disease, and 55 (18%) with TN+ disease. Comparing ahead-10-year patient group (1995-2005) and later-10-year group (2005-2015), a decreasing in proportion of T2 disease (28% vs 15%, p = 0.08), and increasing proportion of lymph node positive disease (13% vs 23%, p = 0.03) were found. The median follow up period was 36 months (0.5 – 263.9). 5-year overall survival was 0.53 ± 0.03 months, and 10-year overall survival was 0.39 ± 0.04 months. Later-10-year group demonstrated a poorer outcome in recurrence-free survival compared to ahead-10-year group in univariate analysis (HR = 1.50 (1.03-2.20), p = 0.036), but not in multivariate analysis (HR = 1.52(0.80-2.87), p = 0.20).
Conclusions: Patients underwent radical cystectomy for management of bladder urothelial carcinoma has demonstrated a demographic shift during the past 20 years. A decreasing in organ-confined (T2) disease and an increasing in lymph node positive disease was observed.