经尿道膀胱肿瘤电切术后病理分期升级预测因素分析

Predictors of pathological upstaging after transurethral resection of bladder tumor

目的:探讨经尿道膀胱肿瘤电切术术前临床分期评估的准确性及预测术后病理分期变化预测因素。方法:收集2010年1月~2014年1月我院258例行经尿道膀胱肿瘤切除术患者的临床病例资料,包括患者年龄、性别、肾积水情况、尿脱落细胞学、双合诊结果、既往膀胱癌病史、术前临床分期和术后病理分期等。比较术前临床分期与术后病理分期差别,Logistic回归分析膀胱癌术后病理分期升级与降级的影响因素。结果:术前临床分期与术后病理学分期一致的共224例(86.8%),34例(13.2%)存在差异(29例出现术后病理分期升级,5例出现术后病理分期降级)。多因素Logistic回归分析提示双合诊中触及明显肿块的是术后病理分期上调的预测因子(95%CI:2.25~58.21,OR=11.43,P<0.01)。结论:膀胱癌术前临床分期与术后病理分期准确性高,术前双合诊是术后病理分期升级的独立预测因素。

Objective：To determine the accuracy of clinical stage after transurethral resection of bladder tumor and to identify factors predicting the discrepancy between clinical stage and pathological stage.Method：We retrospectively reviewed 258 patients who underwent transurethral resection of bladder tumor from January 2010 to January 2014.Clinicopathological characteristics were collected to compare the difference between clinical stage and pathological stage.Logistic regression analysis was performed to determine predictors of pathological upstaging.Result：The concordance rate was 86.8%（224/258）between clinical stage and pathological stage.Stage was upgraded in 29 patients and was downgraded in 5 patients.Multivariate logistic regression analysis indicated that the presence of a palpable mass in the bimanual examination was a predictor of pathological upstaging（P〈0.01,OR=11.43,95%CI：2.25-58.21）.Conclusion：This study demonstrated the high accuracy between clinical and pathological stage.A palpable mass in the bimanual examination was an independent predictor of pathological upstaging.