浅表性膀胱癌经尿道电切术后复发的原因及预防策略

Reasons and preventive strategies of post-TUR neoplasm recurrences for superficial transitional cell carcinoma

目的探讨浅表性膀胱癌(superficial transitional cell carcinoma,STCC)经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBt)后复发的原因及预防策略。方法随机选取我院2001年1月至2007年6月收治的128例STCC患者(对照组)行TURBt术后丝裂霉素C膀胱灌注化疗,另取2007年7月至2011年12月81例STCC患者(观察组)行TURBt术后丝裂霉素C+干扰素联合膀胱灌注化疗,回顾性分析其肿瘤复发情况、化疗方案、手术操作规范等,结合文献探讨其术后复发的原因及预防措施。结果 209例患者术后获随访(31±3)个月,总复发率28.23%,12例术后病理分期分级进展。观察组肿瘤复发率为14.15%,对照组为36.72%;单发肿瘤复发率为23.23%,多发为42.59%;Ta期6.25%,T1期34.78%;G1级17.05%、G2级37.25%、G3级62.07%。观察组获得肿瘤分期、分级、数目等情况与对照组无明显差异(P>0.05),但观察组肿瘤复发率较对照组低(P<0.01);单发、Ta期、低级别的肿瘤的复发率分别较多发、T1期、高级别的肿瘤低(P<0.01)。结论 STCC经尿道电切术后复发主要原因是肿瘤高分级及高分期,肿瘤多发性及非乳头状,肿瘤基底电切深度及范围不够,肿瘤周围存在肉眼难以发觉的隐性卫星病灶及人为因素遗漏小肿瘤,膀胱内残留肿瘤组织碎片种植,灌注化疗失败等。规范化彻底性切除肿瘤原发病灶,术后即刻开始联合应用化学药物及免疫生物制剂规范化膀胱灌注化疗,可提高临床疗效,降低复发率。

Objective To analyze the reason and preventive strategies of neoplasm recurrences after transurethral resection （TUR） for patients with superficial transitional cell carcinoma （STCC）. Methods From Jan. 2001 to Jun. 2007, 128 randomly STCC patients who had undergone TUR in our hospital and received vesical irrigative chemotherapy merely with Mutamycin C after surgery, were assigned as the control group. Another series of 81 STCC patients in our hospital from July 2007 to Dee 2011 were selected as the ob- servation group, and these patients received vesical irrigative chemotherapy with mutamycin C, as well as inter- feron after TUR. Of all patients, clinical data such as neoplasm recurrence, chemotherapy schemes and opera- tive procedures, etc. was analyzed and summarized. Subsequently, a discussion on high risks of postoperative recurrences and the preventive measures was made combined with the latest literatures. Results A total of 209 patients were followed up for an average time of 31 ＋ 3 months, with a total recurrence rate of 28.23%. Twelve patients accepted reoperation and presented a progression in elinicopathologic stage and/or grade. For all pa- tients, the percentages of single, multiple tumors, stage Ta, T1, grade 1, 2 and 3 tumors were 23.23%, 42.59%, 6.25%, 34.78% , 17.05%, 37.25% and 62.07% , respectively. No difference in tumor stages, grades, and numbers was found between observation and control groups （ P 〉 0. 05 ）. The recurrence rate for observation group was significantly lower than control group （ 14.15% vs 36.72% , P 〈 0.01 ）. Furthermore, recurrence rates for single tumors, stage Ta or low grade tumors was significantly lower than multiple tumors, stage T! or high grade tumors, respectively （P 〈0. 01 ）. Conclusion There are various high risks associated with recurrences of STCC patients after TUR, such as those with high grades, at advanced stages, multiple le- sions and non-papillary growth patterns of tumors, as well as invisible satellite lesions, omissions of small tumors due to anthropic factors, replantation of residual tumor fragments, failure of irrigative chemotherapy, etc. A standardized thoroughly resection of the primary tumor, combined with normalized vesical irrigative chemotherapy using chemicals and immunoreagents, including chemotherapy instantly after TUR, will promote the clinical outcome and decrease the recurrence rate.