RadicalCystectomyAsPrimaryTherapyforTGBladderCancer根治性膀胱切除术对于TG膀胱癌的主要疗法.pptxVIP

会计学1RadicalCystectomyAsPrimaryTherapyforTGBladderCancer根治性膀胱切除术对于TG膀胱癌的主要疗法 T1G3 Bladder Cancer“THE FACTS”Is a potentially lethal tumorThis is NOT a superficial tumorUnderstaging occurs frequentlyHigh recurrence rate and progression despite intravesical therapyPoor markers available to accurately identify high risk lesions Can be effectively CURED by early definitive surgery (radical cystectomy)第1页/共17页 BLADDER CANCER:TWO PATHWAYS OF PROGRESSIONNORMALUROTHELIUMTaTa9qDelRAST1T2-4N+/M+9pDel(INK4A)(Presti et al, Ca Res 91; Cordon-Cardo et al, JNCI 92; Dalbagni et al, Lancet 93; Sarkis et al, JNCI 93; Cairns et al, Science 94; Orlow et al, JNCI 95; Li et al, Am J Path 96; Rabbani et al, JNCI 99; McShane et al, Ca Res 2000; Hernando et al, Int J Ca 2001; Sanchez et al, Ca Res, 2002; Veltman et al Ca Res, 2003 )TisT1T2-4N+/M+TP53RB5qDel, 3pDel10qDel, 11pDel, 18qDel14qDel第2页/共17页 T1G3 Bladder CancerCan we accurately detect this disease?Are we at risk for understaging?第3页/共17页 T1G3 And TIS Bladder CancerClinical UnderstagingAuthorP stage T1Amling (Duke), 199437%Soloway (Florida) 199436% (60% for Tis)Stein (USC) 200139%10 - 15% have positive nodes at cystectomy第4页/共17页 Risk Of Understaging Is Influenced By Presence Of Muscle In TUR SpecimenDutta, J Urol 166:490, 2001N=78Herr, HW J Urol 162:74, 1999A second TURBT required to identify extent of disease.第5页/共17页 T1G3 Bladder CancerOutcome Of Understaged PatientsDisease Specific OutcomesFreeman et al, Cancer, 1995179 patients (71% with T1 tumors)53% failed intravesical therapyUnderstaged lesions do significantly worseUnderstaged lesions WILL NOT respond to bladder sparing approaches第6页/共17页 Repeat TURBT May Help Reduce UnderstagingDalbagni et al, UROLOGY 2002第7页/共17页 T1G3 Bladder CancerNatural HistoryRecurrence and Progression RiskRecurrence RiskFollowing TURBT, 69-80% risk of recurrenceIntravesical immunotherapy can delay recurrence and progression, but long-term will not alter natural historyProgression Risk33