原发性T1G3膀胱癌复发后病理分级减低现象的临床意义

Grade regression after recurrence in primary T1G3 bladder cancer

目的 探讨原发性T1G3膀胱癌复发后病理分级减低现象的临床意义。方法 回顾性分析1995年至2004年收治55例原发性T1G3膀胱癌患者的临床资料。55例首次手术方法均采取经尿道膀胱肿瘤电切术，术后均出现复发，次数1～9次。依据复发后是否发生病理分级减低分为2组：A组21例（38．2％），复发后有病理分级减退现象；B组34例（61．8％），复发后病理级别不变。对2组患者性别、年龄、肿瘤大小、是否多发、术后是否膀胱灌注、复发后肿瘤是否浸润肌层、肿瘤病理分级改变以及无瘤生存期等资料进行对比分析。结果 A组原发肿瘤直径〉3cm者9．5％（2／21），复发后肿瘤肌层浸润者23．8％（5／21）；而B组分别为38．2％（13／34）和52．9％（18／34），2组差异有统计学意义（P=0．020，0．033）。2组患者5年无瘤生存率分别为（66．8±16．6）％和（50．5±12．9）％，差异有统计学意义（P=0．038）。Cox多因素回归分析显示，病理分级减退现象为影响生存率的独立指标（P=0．044）。结论 原发性T1G3膀胱癌患者复发后病理分级减低者预后相对较好，复发后病理分级减低可作为判断预后的独立因素。

Objective To evaluate the phenomenon of grade regression after recurrence in primary stage T1 Grade 3 bladder cancer. Methods Fifty-five cases of primary stage T1 Grade 3 bladder cancer were treated by transurethral resection of the bladder tumor （TURBT） between 1995 and 2004. All cases got recurrence, varying from 1-9 times. Two groups were divided by grade regression after recurrence. Twenty-one cases （38.2%）, group A, got grade regression after recurrence, while group B consisted of 34 cases （61.8%） with no grade regression. Clinical data were analyzed statistically, including sex, age, tumor size, tumor multiplicity, intravesical instillation, muscle invasion, pathological grade alteration and disease free survival. Results Patients of group A had less tumor size 〉3 cm 9.5%（2/21） and muscle invasion 23.8%（5/21） than those of group B, 38.2%（13/ 34） and 52.9% （18/34）, respectively （P=0. 020,0. 033）. The five-year disease-free survival rates of two groups were 66.8%o and 50.5%0, respectively. Grade regression group had higher survival rate than non-regression group（P = 0. 038）. In COX regression analysis, grade regression was the independent predictor for recurrence-free survival （P= 0. 044）. Conclusions Patients could have better prognosis with grade regression after recurrence in primary stage Ta Grade 3 bladder cancer. And grade regression coule be an independent variable to predict the prognosis.