膀胱小细胞癌5例临床分析

目的探讨膀胱小细胞癌的临床特点及诊治疗效。方法对5例膀胱小细胞癌的病理及临床资料进行回顾性分析。结果 5例患者,男3例,女2例,平均年龄63岁（51～94岁）。肿瘤分期T2N0M03例,T3N0M01例,T4N1M01例。肿瘤电切加全身化疗2例,根治性膀胱全切2例,姑息膀胱切除加化疗1例。3例死于肿瘤复发或转移,平均存活时间6个月（2～12个月）,2例分别随访10个月及20个月仍存活。结论膀胱小细胞癌预后差,手术联合化疗可提高治愈率。     

膀胱小细胞癌的诊断与治疗(附6例报告)

目的：探讨膀胱小细胞癌的临床特点及诊治疗效。方法：对6例膀胱小细胞癌患者的临床资料进行回顾性分析。结果：6例患者，男4例，女2例，平均年龄63岁（51～71岁）。肿瘤分期T2N0M02例，T3N0M0 1例，T4N0M0 2例，T4N2M1 1例。肿瘤电切加化疗1例，根治性膀胱全切2例，姑息膀胱切除加化疗2例，肿瘤电切、髂动脉栓塞及全身化疗1例。4例死于肿瘤复发或转移，平均存活时间7个月（2～15个月），2例分别随访18个月及21个月仍存活。结论：膀胱小细胞癌预后差，治疗应以手术结合放化疗。     

膀胱小细胞癌(附4例报告)

目的：探讨膀胱小细胞癌（SCC）的诊断和治疗。方法：对4例膀胱SCC的病理及临床资料进行回顾性分析。结果：男3例，女1例，平均66.5岁。分期：T4N0M01例，T4N1M02例，T4N4M11例。根治性膀胱切除术加放疗2例，膀胱部分切除术1例，肿瘤无法切除而行右输尿管皮肤造瘘术1例。2例死于肿瘤复发或转移，平均生存时间6.5个月，另2例已分别生存6个月和3个月，仍在随访中。结论：膀胱SCC预后极差，行根治性切除术加联合化疗或放疗可提高治愈率。     

泌尿系小细胞癌的诊断及治疗（附11例报告）

目的：探讨泌尿系小细胞癌的诊治方法、疗效及预后。方法：回顾性分析我院2003年1月～2012年12月收治的t1例泌尿系小细胞癌的病理、临床特征、诊断方法、治疗方法等资料,并对患者治疗效果、生存期等进行分析。结果：11例患者,男9例,女2例,平均年龄66．9（57～83）岁,肿瘤位于膀胱5例（1例为女性）,右肾3例（1例为女性）,左肾1例,前列腺2例。按TNM分期,膀胱肿瘤：T2bNnM01例,T2bN1M0 1例,2例均行根治性膀胱全切＋肠代膀胱术,分别于术后24个月及13个月死亡;T2bN2M1 1例,T3bN2M1 1例,此2例行根治性膀胱全切＋放疗＋化疗,分别于术后9个月、12个月死亡;T4N2M1 1例,行放疗＋化疗,3个月后死亡。肾脏肿瘤：T1aN0M01例,T1nN0M0 1例,T2bN1M0 1例,T3bN2M1 1例,均行根治性肾切除术＋放疗＋化疗,3例于术后6个月、13个月、24个月死亡,1例至今4年尚存活。前列腺肿瘤：T1cN0M1b 1例,行前列腺电切＋放疗＋化疗;T3bN1M1c 1例,行放疗＋化疗,随访时分别死于术后25个月及15个月。11例患者生存期最短3个月,目前最长48个月,平均17．5个月;1年生存率63．6％（7／11）,5年生存率目前为0。结论：泌尿系小细胞癌恶性度高,预后差,手术联合放化疗可能会延长患者生存期、改善其生活质量。     

浸润性膀胱癌保留膀胱术后辅助性动脉化疗的近期疗效

目的 评价浸润性膀胱癌保留膀胱手术联合动脉化疗的临床疗效.方法 2003年4月至2006年1月,采用经尿道膀胱肿瘤电切或膀胱部分切除术联合GC(吉西他滨+顺铂)方案动脉化疗治疗浸润性膀胱癌患者30例.患者中男28例,女2例.平均年龄60岁.按AJCC(2002年)肿瘤分级分期标准,膀胱移行细胞癌Ⅱ级5例、Ⅲ级20例、Ⅲ级合并腺癌3例、Ⅲ级合并鳞癌1例,腺癌1例;T2N0M024例、T2N1M01例、T3N0M04例、T3N2M01例.总结30例患者的肿瘤控制情况、生存率和保留膀胱生存率.结果 30例平均随访23(5～38)个月,1例无瘤生存11个月后失访,余29例中无复发及转移17例,出现转移并死亡4例,复发8例;其中浅表性复发5例,浸润性复发3例;29例中保留膀胱手术21例,全膀胱切除术4例.2年无瘤生存率88%,2年保留膀胱生存率72%.患者对动脉化疗耐受良好,无严重全身和局部不良反应. 结论保留膀胱手术联合GC方案动脉化疗治疗浸润性膀胱癌近期疗效良好,不良反应轻,患者耐受良好,远期疗效需进一步观察.     

改良根治性全膀胱切除原位新膀胱术(附9例报告)

目的探讨改良根治性全膀胱切除原位新膀胱术的临床疗效。方法采用改良全膀胱切除回肠新膀胱术治疗浸润性膀胱癌9例,均为男性,年龄40～64岁,平均55岁。尿路上皮癌8例,按WHO分级标准,Ⅱ级5例,Ⅲ级3例;腺鳞癌1例。肿瘤多发6例,均为尿路上皮癌,肿瘤最大径1.5～11.0cm。TNM临床分期:T2N0M07例,T3N0M01例,T4N1M01例。结果手术时间210～330min,平均260min。术中出血量200～800ml。输血5例,输血量400～600ml。病理分期:T2aN0M05例,T2bN0M01例,T4aN0M02例,T4N2M01例。9例患者术后均获得随访,随访时间10～64个月。7例无瘤生存,肾功能良好;2例术后2年死亡(1例腺鳞癌者死于全身转移,1例死于意外事故)。所有病例白天控尿均良好,夜间控尿良好5例,剩余尿量0～50ml。1例术后出现上尿路扩张积液、肾功能不全,为两侧输尿管末端粘连所致,经内镜下粘连松解后积液消退,肾功能恢复正常。2例年龄<50岁者,术后6个月有阴茎勃起,服用西地那非片可完成性活动。结论改良根治性全膀胱切除原位新膀胱术是治疗浸润性膀胱癌的理想方法之一。     

原发性膀胱小细胞癌(附4例报告)

目的 提高对膀胱小细胞癌的认识水平。方法 对4例膀胱小细胞癌的病理及临床资料进行回顾性分析。结果 4例患者中男3例，女1例，平均年龄69．5。其中3例行根治性膀胱全切加化疗，1例行姑息性膀胱全切。3例死于肿瘤复发，平均生存20个月，1例存活7年。结论原发性膀胱细胞癌恶性程度高、预后差，根治性膀胱全切加联合化疗可获得较好的疗效。     

改良全膀胱切除原位新膀胱术96例报告

目的 总结改良全膀胱切除原位新膀胱术治疗浸润性膀胱癌的临床经验。方法 采用改良全膀胱切除原位新膀胱术治疗局部浸润性膀胱癌患者96例，患者均为男性，平均年龄55岁。96例中移行细胞癌91例，WHO分级Ⅲ级39例、Ⅱ级51例、Ⅰ级1例；鳞癌3例；腺癌2例。肿瘤多发92例（移行细胞癌91例、腺癌1例），单发4例（鳞癌3例、腺癌1例）。TNM临床分期T2N0M088例，T3N0M06例，T3N1M02例。统计手术时间、术中出血和输血量，对新膀胱功能、并发症、肿瘤控制和患者生存情况进行随访分析。结果 96例患者无手术死亡，手术时间190～330min，平均260min。术中出血150～1200ml，输血30例。病理分期T1N0M01例，T2N0M089例，T3aN0M、T3aN1M0和L3bN1M0各2例。随访5～58个月，平均31个月。无瘤生存94例，因肿瘤死亡2例。新膀胱白天控尿良好93例（97％），夜间控尿良好80例（83％）。剩余尿量0～80ml者87例，100～250ml者7例。主要并发症：切口裂开3例，二次缝合治愈；输尿管吻合151漏1例，再吻合后治愈；输尿管口狭窄2侧和输尿管口粘连4侧，经内镜下手术纠正；严重肠梗阻3例和慢性酸中毒低钾2例均经内科处理纠正。无严重远期并发症。结论 改良全膀胱切除原位新膀胱术后肿瘤控制满意，严重并发症少，新膀胱控尿良好，患者生活质量高，是目前治疗浸润性膀胱癌的理想方法之一。     

浸润性膀胱癌术前选择性髂内动脉灌注化疗的近远期疗效观察

目的　观察选择性髂内动脉灌注化疗联合手术治疗浸润性膀胱癌的近远期效果。　方法　通过双侧股动脉插管对 5 6例浸润性膀胱癌患者进行选择性髂内动脉灌注化疗 (顺铂加阿霉素 ) ,2次化疗间隔 3～ 4周。化疗 2周后复查膀胱镜和B超。化疗后根据临床分期采用保留膀胱或膀胱全切手术。　结果　动脉化疗后肿瘤体积缩小和临床分期降低 4 2例 ,肿瘤体积和分期不变或增加 14例。化疗后 5 6例患者根据肿瘤大小和临床分期行经尿道膀胱肿瘤切除 2 1例 ,膀胱部分切除术 5例 ,根治性膀胱全切术 2 8例 ,2例分别行单纯回肠膀胱术和输尿管皮肤造口术。随访 4 0例肿瘤切除患者 ,1、2、3、5年无瘤生存率分别为 85 .0 % ,70 .0 % ,5 7.5 %和 5 0 .0 %。　结论　术前动脉化疗可使多数浸润性膀胱癌降期 ,使部分患者接受保留膀胱手术 ,部分高分期 (T4)患者接受根治性膀胱切除术 ,可有效降低浸润性膀胱癌的复发率和改善预后     

膀胱小细胞癌诊治体会(附六例报告)

目的　提高对膀胱小细胞癌的认识。　方法　回顾性分析 6例膀胱小细胞癌患者的病理及临床资料。男 4例 ,女 2例 ,平均年龄 5 1岁。其中 2例膀胱小细胞癌含有移行细胞癌和 (或 )腺癌成分。行膀胱部分切除术 2例 ,行膀胱全切术 4例。 5例患者接受 2～ 6疗程化疗。　结果　 6例患者随访 12～ 6 0个月 ,均因肿瘤复发死亡。平均生存时间 2 8个月。　结论　膀胱小细胞癌占原发膀胱恶性肿瘤的 0 .4 4 % ,恶性程度高 ,易发生淋巴结、肝、骨等转移 ,预后差 ,根治性膀胱全切加联合化疗可获得较好疗效。     

原发性膀胱小细胞癌3例的诊断和治疗

目的 认识原发性膀胱小细胞癌的发病和临床特点,提高对该病的诊治水平。方法 分析3例原发性膀胱小细胞癌患者的临床资料,结合文献对该病的病理学及临床特征、诊断、治疗和预后进行讨论。结果本组原发性膀胱小细胞癌3例,其中2例经手术、1便经膀胱镜下活检病理证实为膀胱小细胞癌。1例T_4M_1经化疗三月后死亡,1例T_(3a)M_0行膀胱部分切除术,术后予以化疗,一年后死于心梗,1例T_4M_0行根治性膀胱切除术,术后予以放疗,仍在随访中,无复发及转移。结论 原发性膀胱小细胞癌系高度恶性肿瘤,其治疗方式是根治性膀胱切除术辅以术后放疗,化疗疗效尚不肯定。     

Spindle and giant cell carcinoma of the bladder. Report of 3 cases

3 cases of spindle and giant cell carcinoma are reported. 2 patients with T3N0M0 and T3N1M0 tumors underwent radical cystectomy. They died 8 and 9 months after cystectomy for local recurrence and tumor metastases. Neither radiotherapy nor chemotherapy were effective in these 2 patients. 1 patient with T1NXM0 disease underwent resection of the tumor through cystotomy. Although she had neither adjuvant chemotherapy nor radiotherapy, she is well without recurrence 6 years after surgery. Early surgical resection of the tumor may be the only currently accepted therapy of spindle and giant cell carcinoma of the bladder.     

Long-term follow up of patients with invasive bladder carcinoma receiving combined cisplatin-based intra-arterial chemotherapy and radiotherapy

OBJECTIVES: Combined cisplatin-based intra-arterial chemotherapy and radiotherapy is an effective treatment for patients with locally invasive bladder carcinoma. We report long-term follow-up data regarding definitive treatment of locally invasive bladder carcinoma, regardless of whether bladder preservation was possible. METHODS: The follow-up data from 24 patients (18 males and six females; aged, 31-85 years; median, 73 years) with invasive bladder carcinoma, between 1993 and 2003, was examined. The clinical stages of the patients ranged T2-T4, all N0M0, and involved 13 patients at T2 (T2a, T2b), seven patients at T3 and four patients at T4. Combined cisplatin-based intra-arterial chemotherapy and radiotherapy was performed. RESULTS: The 5-year overall survival rate and cancer-specific survival rate for all patients were 81.6% and 85.6%, respectively. When the patients were divided into complete response (CR) of 10 patients and non-CR groups of 14 patients, the 5-year overall survival rate for the CR group was 87.5%, while that of the non-CR group was 78.6% (P = 0.58). The tumor grade of the CR group was significantly lower than that of the non-CR group (P = 0.01). When the non-CR group was divided into radical cystectomy and non-radical cystectomy groups, the 5-year overall survival rate for the radical cystectomy group (100%) was higher than that of the non-radical cystectomy group (70%). CONCLUSION: This combined chemo-radiotherapy was effective for local invasive bladder carcinoma, leading to the possibility of bladder preservation using this therapy.     

Small cell carcinoma of the urinary bladder treated with chemotherapy and radiotherapy: results in five cases

Small cell carcinoma of the bladder is a rare and highly aggressive tumor. We report our experience with 5 consecutive patients treated with systemic chemotherapy and adjuvant radiotherapy. TNM stages were T2N0M0 (1 patient), T3aN0M0 (3 patients) and T3bN1M0 (1 patient). The chemotherapy protocol was the one used with small cell lung cancer patients at our hospital: six cycles of alternating PE/CAV (PE: cisplatin, etoposide; CAV: cyclophosphamide, doxorubicin, vincristine). Cystoscopy was performed after the third cycle. Four out of 5 patients were free of macroscopic disease. The fifth patient had persistent lesions and was treated by cystectomy. This patient developed a local-regional recurrence 4 months later and died shortly afterwards. Four patients completed the planned six cycles. Cystoscopy with bladder biopsy was then performed on each, and all had complete remission. They were treated with external radiotherapy (45 Gy pelvis, 60 Gy bladder). One patient had invasive bladder recurrence 12 months later and cystectomy was performed. At the last follow-up 42 months later, he was alive and well. The other 3 patients were alive and free of disease 60, 48 and 27 months after diagnosis, respectively. These results are clearly more favorable than previous reports. Cystectomy might, therefore, be unnecessary in some patients.     

Small cell carcinoma of the urinary bladder: a case report

We report a case of small cell carcinoma of the urinary bladder. The patient was a 58-year-old man complaining of gross hematuria. Clinical examination revealed a non-papillary, broad-based tumor on the right bladder wall with a clinical stage of T3a, N0, M0. Neoadjuvant intraarterial infusion chemotherapy with methotrexate, adriamycin and cisplatin was performed, but it was ineffective. Three weeks later we performed a radical cystectomy. The operative specimen of the tumor revealed small cell carcinoma. It was staged pT3aN0M0R0L2V1. Postoperatively, 1 course of adjuvant chemotherapy using cisplatin and etoposide was performed. The patient is alive without any evidence of tumor recurrence at 6 months after operation.     

Neoadjuvant chemotherapy (M-VAC) for locally invasive bladder cancer]

Eight patients with locally invasive bladder cancer (stages T2-T4, N0, M0; 7 men and 1 woman; mean age, 72.0 years; age range, 56 to 80 years) were treated with 2 cycles of neoadjuvant chemotherapy consisting of methotrexate, vinblastine, adriamycin and cisplatin (M-VAC). Seven of them underwent radical cystectomy after chemotherapy, while the bladder was preserved in one patient. Seven patients were free of disease during a mean follow-up period of 26.2 months (range 20-30 months). However, one patient whose pathological stage was pT2, N1 died with disease 27 months after radical cystectomy. The patient whose bladder had been preserved showed no recurrence after a follow-up period of 27 months. Pathological examination of the resected specimen after chemotherapy revealed no tumor tissue in three patients; one with negative cytology and two with positive cytology. Downstages were observed in two patients. Results showed that the toxicity of neoadjuvant M-VAC therapy is acceptable and that M-VAC therapy is effective against locally invasive transitional cell carcinoma of the bladder. The problem remains of how to assess the clinical stage more accurately before chemotherapy and radical cystectomy.