非肌层浸润性膀胱癌伴术前脓尿的临床特点及预后分析

Prognostic significance of preoperative pyuria in patients with non-muscle-invasive bladder cancer

目的：探讨非肌层浸润性膀胱癌（non-muscle-invasive bladder cancer,NMIBC）伴术前脓尿患者的临床特点及脓尿对其预后方面的临床意义。方法：回顾性分析2009年11月～2011年3月我院278例首发非肌层浸润性膀胱癌患者的临床病理资料。定义脓尿为每高倍视野下尿白细胞数量≥5个,根据术前尿白细胞值,将患者分为脓尿-组（尿白细胞〈5）和脓尿＋组（尿白细胞≥5）,运用卡方检验分析脓尿和各临床病理特点之间的关系,运用Kaplan-Meier法比较两组之间无复发生存期（recurrence-free survival,RFS）和无进展生存期（progression-free survival,PFS）的区别,并用Log-rank检验评估其统计学意义。结果：278例NMIBC患者中,有98例（35.3%）出现术前脓尿,平均随访48.6（3～72）个月。在随访期间内,脓尿的出现与大体积、多发、高TNM分期、高级别肿瘤以及高复发率和高进展率显著相关,且经Kaplan-Meier法分析发现,脓尿＋组患者无复发生存率明显低于脓尿-组患者（58.2%vs.71.7%,P=0.016）;同样,脓尿＋组患者无进展生存率也明显低于脓尿-组患者（74.5%vs.85.6%,P=0.018）。结论：非肌层浸润性膀胱癌伴术前脓尿患者肿瘤多发且体积大,组织学分级和临床分期高,预后较差,应积极手术治疗并术后密切随访。

Objective：To evaluate the prognostic significance of preoperative pyuria in patients with non-muscle-invasive bladder cancer（NMIBC）.Method：We retrospectively reviewed data from 278 patients diagnosed with NMIBC in our institute from November 2009 to March 2011.Pyuria was defined as urine containing ≥5 white blood cells per high power field.We divided the 278 consecutive patients into two groups named as pyuria（-）and pyuria（＋）.Correlations among pyuria with other clinical and pathological features were assessed by chi-square.Recurrence-free survival（RFS）and progression-free survival（PFS）curves were estimated using the Kaplan-Meier method.Log-rank test was conducted to evaluate the statistical significance.Result：Among 278 consecutive patients,98（35.3%）patients had preoperative pyuria.The mean follow-up period was 48.6（3-72）months.During the follow-up period,pyuria was significantly associated with large tumor size,multiple tumors,T1 tumors,high-grade tumors,high recurrence rate and high progression rate.RFS of patients with pyuria was significantly lower than those without pyuria（58.2% vs.71.7%,P =0.016）.Similarly,PFS was lower in the pyuria（＋）group（74.5% vs.85.6%,P =0.018）.Conclusion：Preoperative pyuria seems to be significantly associated with poor clinical outcomes in patients with NMIBC.These patients should be treated actively and followed up closely.