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頁籤選單縮合
題名 | 侵犯性上泌尿道移形上皮細胞癌之治療=Treatment of Invasive Transitional Cell Carcinoma of Upper Urinary Tract |
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作者 | 胡渝昌; 劉文山; 葛魯蘋; 林立青; 陳建勳; 張慶雄; | 書刊名 | 放射治療與腫瘤學 |
卷期 | 6:1 1999.03[民88.03] |
頁次 | 頁17-23 |
分類號 | 416.27、416.27 |
關鍵詞 | 移形上皮細胞癌; 上泌尿道; 輸尿管腫瘤; 第二個泌尿道腫瘤; Transitional cell carcinoma; Upper urinary tract; Ureteral tumor; Second location tumor; |
語文 | 中文(Chinese) |
中文摘要 | 目的:回顧高雄榮民總醫院侵犯性上泌尿道移形上皮細胞癌的治療結果。材料與 方法: 自 1991 年 3 月至 1996 年 12 月共有 46 位侵犯性上泌尿道移形上皮細胞癌的病 患接受根除性手術,其中男性有 31 位,女性有 15 位,年齡分佈為 43 至 82 歲(中位數 67 )。 其中有 16 位接受手術後放射線治療, 總劑量範圍是 48.6 至 60Gy (中位數 55 );14 位接受手術後化學治療,使用 MVEC ( methotrexate, vinblastine, epirubicin, cisplatin )或 MCV ( methotrexate, cisplatin, vinblastine ) 2 至 12 個療程(中 位數 4 )。T2、T3、T4 ( AJC,1992 )各有 20、21、5 例,手術時已有淋巴結轉移者有 4 例,輸尿管腫瘤者有 24 例。結果:經過 5-65 個月的追蹤(中位數 32 ),發生局部復 發者有 7 例( 15 %),發生遠端轉移者有 16 例( 35 %)。所有病患的 5 年存活率是 19 %,5 年無病存活率是 16 %。 預後因子中,手術時沒有淋巴結轉移及原發部位為輸尿 管腫瘤對 5 年存活率與 5 年無病存活率而言是預後較佳因子且達到統計上的差異。單獨手 術者、 手術後放射線治療者及手術後化學治療者之 5 年存活率分別是 16 %、12 %及 37 %( p=0.43 ),而 5 年無病存活率分別是 15 %、10 %、27 %( p=0.37 )。 手術後 放射線治療者無嚴重併發症發生。手術時已有淋巴結轉移者有 4 例,其中 3 例發生遠端轉 移而且已死亡。 發生第二個泌尿道腫瘤者有 8 例,發生部位均在膀胱。結論:不論是否給 予手術後放射線治療或化學治療,均有相當高比例的病人發生遠端轉移。手術時沒有淋巴結 轉移及原發部位為輸尿管腫瘤對 5 年存活率與 5 年無病存活率而言是預後較佳因子。手術 後化學治療者的 5 年存活率與 5 年無病存活率較單獨手術者與手術後放射線治療者為佳, 雖未達到統計上的意義,但值得進一步研究。 |
英文摘要 | Purpose:To review the treatment results of invasive transitional cell carcinoma of upper urinary tract at Veterans General Hospital-Kaohsiung. Materials and Methods: From March 1991 to December 1996, 46 patients with invasive transitional cell carcinoma of the upper urinary tract received radical surgery. There were 31 male and 15 female patients. Patients's age ranges between 43 and 82 years. ( median: 67 ).Sixteen patients received post-operative radiotherapy with dosages of 48.6 to Gy ( median: 55 ) to the tumor bed. Fourteen patients received 2 to 12 courses ( median: 4 ) of post-operative chemotheray using regiments of MVEC ( methotrexate, vinblastine, epirubicin, cisplatin ) or MCV ( methotrexate, cisplatin, vinblastine ). Twenty, 21,5 patients were pathologically staged as T2,T3,T4 ( AJCC,1992 ), respectively. Four patients had lymph node metastasis pathologically. Twenty four patients had tumor confined to ureter only. Results:Follow-up duration ranges from 5 to 65 months ( median: 32 ). Overall,7 patients ( 15 %) developed local recurrence and 16 patients ( 35 %) developed distant metastasis. Overall 5-year survival rate ( 5 YSR ) was 19 %, and 5-year disease-free survival rate ( 5 DFS ) was 16 %. Negative lymph nodes metastasis and the ureteral tumor only were statistically significant good factors for 5 YSR and 5 DFS. 5 YSR for surgery alone group, post-operative radiotherapy group and post-operative chemotherapy group were 16 %, 12 % and 37 % respectively ( p=0.43 ). 5 DFS for the aforementioned treatment arms were 15 %, 10 % and 27 % respectively ( p=0.37 ). No severe complications were observed in patients with post-operative radiotherapy. Three out of the 4 patients with lymph node metastasis developed distant metastasis and died. Eight patients had second location tumors, all of which occurred in the bladder. Conclusions: This study showed relative high incidences of patients developing distant metastasis regardless of treatment arms was given. Negative lymph node metastasis and the ureteral tumor only were good factors for 5 YSR and 5 DFS. The post-operative chemotherapy group had a higher 5 YSR and 5 DFS than the other treatment groups, and the results need further confirmation although it was not statistically significant. |
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