表浅性膀胱移行细胞癌术后随访策略的探讨

Strategy for Diagnosis of Recurrence of Superficial Bladder Cancer After Primary Resection

目的:研究表浅性膀胱癌复发规律,探讨术后复查策略。方法:回顾分析200例表浅性膀胱移行细胞癌病例,均行尿道膀胱肿瘤电切除术（TUR-Bt）。根据肿瘤分级、病理分期和肿瘤数目进行复发的低、中和高风险分组,应用SSPS软件,针对复发时间进行统计分析。结果:本组均获随访,随访期6-78个月,复发160例（80％）。复发时间为术后3-72个月,平均38个月。术后病理分期与分级较初发时进展45例（28.1％）。Kaplan-Meier曲线分析显示,随着风险分组级别的增高,复发时间缩短。低、中和高风险组复发时间分别为（37.05±16.0）个月、（22.22±12.05）个月和（12.60±7.80）个月。结论:对于表浅性膀胱移行细胞癌,可以通过复发风险分组进行预后佑计。低和中度风险的表浅性肿瘤,术后膀胱镜复查可以改变为每6个月1次,从而减少创伤性检查频度及病人心理负担。

Objective: Our aims were to discuss the time-related characteristics of recurrent superficial bladder cancer and to present a rational strategy for follow up. Methods: Two hundreds patients with superficial bladder transitional cell carcinoma underwent transurethral resection. They were devided into 3 groups : low-risk, intermediate-risk, and high-risk groups, based on grade, pathological stage, and number of tumors. The time of recurrence was analyzed among 3 risk groups by using SSPS, a statistic software. Results: All patients were followed up for 6 to 78 months , and recurrence were found in 160 patients. The meantime of recurrence was 38 months (3 to 72 months). And 45 cases were in progressed stage or grade after reoperation. The results of Kaplan-Meier curve showed that the time for recurrence was shorter in high-risk group than that of the other two groups. The first time for recurrence in low-risk group and intermediate-risk group were (37.05±16.0) months and ( 22.22±12.05) months, respectively. Conclusion; The prognosis of the superficial bladder cancer can be predicted based on the risk analysis. The cystoscopy for recurrence should be performed every 6 months rather than 3 months on tradition so as to reduce traumatic examination.