非肌层浸润性膀胱尿路上皮癌复发风险的多因素分析

Multivariate analysis of recurrence factors for non-muscle-invasive bladder urothelial carcinomas

目的探讨影响非肌层浸润性膀胱尿路上皮癌复发的相关因素及其临床意义。方法回顾性分析中山大学附属第一医院泌尿外科2003年1月至2009年2月收治的161例非肌层浸润性膀胱尿路上皮癌患者的生存资料，采用Kaplan-Meier法、Log-rank检验及COX比例风险模型对年龄、性别、肿瘤分期、分级、大小、数目及其生长部位、术后维持灌注用药及既往复发情况等影响肿瘤复发的因素进行统计分析。结果单因素分析表明不同肿瘤分期、肿瘤分级、肿瘤数目及既往复发情况间肿瘤复发差异均有统计学意义（均P〈0．05），纳入COX回归模型后得提示肿瘤复发的危险因素为：肿瘤分期（RR=3．810，P=0．001）、肿瘤分级（RR=2．416，P=0．009）、既往复发情况（RR=1．810，P=0．010）、肿瘤数目（RR=1．736，P=0．036）。结论肿瘤分期分级对非肌层浸润性膀胱尿路上皮癌复发影响最大，既往复发情况及肿瘤数目也是复发的相关因素。

Objective To discuss the risk factors of recurrent non-muscle-invasive bladder cancer and elucidate its clinical significance. Methods The retrospective survival analysis of 161 patients with non- muscle-invasive bladder cancer was performed by Kaplan-Meier method, Log-rank test and COX proportional hazard model. Results On univariate analysis, the parameters of tumor stage, tumor grade, number of tumors and previous recurrence were significant for tumor recurrence （ all P 〈 0. 05 ）. On multivariate analysis of COX proportional hazard model, all the above risk factors remained significant for tumor recurrence. The hazard ratios were as follows ： tumor stage （RR = 3. 810, P = 0. 001 ） , tumor grade （ RR = 2. 416, P = 0. 009） , number of tumors （RR = 1. 736, P =-0. 036）and previous recurrence （RR = 1.810, P = 0. 010）. Conclusion Tumor stage and tumor grade plays the most important role in tumor recurrence.