Bladder cancer in patients under 40 years of age:analysis of 92 cases / 中华泌尿外科杂志

ABSTRACT

Objective To evaluate the clinical features,pathological grades,treatment and prognosis in bladder cancer patients under 40 years.Methods A retrospective review of transitional cell carcinoma of the bladder in patients under 40 years who had been treated from January 1994 to April 2005 were conduc- ted.The patients were divided into 2 groups(group A,20-30 years;group B,31-40 years)based on their age.The differences in pathologic grading,recurrence rate and positive rate of urine cytology were compared between the 2 groups.The statistical analyses were performed using x~2 test.Results The incidence of bladder cancer in patients under 40 years was 4.2%(92/2200).The male/female ratio was 2.71.0.At initial visit,86%(68.7% in group A and 91.1% in group B)of the patients presented with gross hematuri- a;and 25.0% in group A and 33.9% in group B concomitantly had frequency and dysuria.The mean disease course in the 2 groups was 3.8 months for male and 6.9 months for female.Solitary tumor occurred in 19 ca- ses(100.0%)in group A and 63(86.3%)in group B;and multiple carcinomas,in 10 cases(13.7%)in group B.All were superficial bladder cancers in group A,while 6(8.2%)were invasive carcinomas in group B.According to WHO pathological grading of bladder cancer,in group A,10 cases(52.6%)had G_1,8 (42.1%)had G_2 and 1(5.3%)had G_3 tumors;in group B,8 cases(11.0%)had G_1,49(67.1%)had G_2 and 16(21.9%)had G_3 tumors(P＜0.01).The positive rate of urine cytology was 53.3% in all 92 ca- ses(25.0% in group A and 60.7% in group B,P＜0.05).The diagnostic rates by B-ultrasound and cysto- scopy were 98.6% and 100.0%,respectively.Of the 92 patients,11(12.0%)were treated by partial cys- tectomy,73(79.3%)by TUR-Bt and 8(8.7%)by cystectomy.The follow-up was 3-115 months(mean, 39 months).The overall recurrence rate was 12.0%,with 5.3%(1/19)in group A and 13.7%(10/73)in group B.Of 10 patients with multiple carcinomas,6(60.0%)developed recurrence;and of 82 with solitary tumors,5(6.1%)developed recurrence,with significant difference between them(P＜0.01).Two of the multiple carcinoma patients developed invasive carcinoma.Conclusions In bladder cancer patients under 40 years,the positive rate of urine cytology,pathological grading and recurrence rate increase with age.Multi- ple tumors,invasive carcinoma and long-term smoking are high risk factors for tumor recurrence.TURBt is the main surgical method for treating bladder cancer patients under 40 years.