二次电切在高危非肌层浸润膀胱癌治疗中的作用

Clinical effects of second resection on high-risk non-muscle invasive bladder cancer

目的探讨二次电切对高危非肌层浸润膀胱尿路上皮癌复发和进展的作用。方法高危非肌层浸润膀胱尿路上皮癌患者150例,在首次经尿道电切术后6周进行第二次经尿道电切78例（二次电切组）,同期未行再次电切而常规治疗随访72例（常规随访组）,比较2组患者的肿瘤复发和进展情况。结果二次电切的78例患者中,发现残存肿瘤者17例（21.8%）,其中残存肌层浸润肿瘤者6例（7.7%）。随访12~54个月（中位时间33个月）,二次电切组的肿瘤复发率和进展率分别为37.5%（27例）和18.1%（13例）,未行二次电切组则分别为66.7%（48例）和20.8%（15例）。二次电切组的肿瘤复发率较低,差异有统计学意义（P〈0.05）,但两组进展为肌层浸润肿瘤的差异无统计学意义（P〉0.05）。首次电切术后半年内两组患者肿瘤复发率的差异有显著统计学意义（P〈0.01）;而首次术后半年后,两组患者肿瘤复发率的差异无统计学意义（P〉0.05）。结论高危非肌层浸润膀胱癌在首次电切术后进行二次电切可降低肿瘤复发率,但不能减少肿瘤进展的风险。

Objective To explore the effects of second resection on the recurrence and progression of high-risk non-mus- cle invasive bladder cancer. Methods We prospectively performed second resection 6 weeks after the first transurethral re- section in 78 patients and compared the tumor recurrence and progression rates with those of 72 patients routinely followed. Results Residual tumors were found in 21.8% （17/78） patients who underwent second resection, including muscle-invasive tumors in 6 patients （7.7 %）. After a median observation of 33 months （12--54 months）, the recurrence rate of patients who underwent second resection was 3 7.5 % （ 2 7 / 72）, which was lower than that of patients routinely followed （ 66.7 %, 48/72, P〈 0.05）. The different recurrence rates between the two groups were mainly manifested within 6 months after the first resection. The progression rate was not difference between the two groups （18.1 %vs. 20.8%, P〉0. 05）. Conclusions Second resec- tion reduces recurrence rate of high-risk non-muscle invasive bladder cancers, but tumor progression seems unchanged.