非肌层浸润性膀胱癌患者肿瘤残留及二次电切术后复发和进展的单中心因素分析

The tumor residual,recurrence and progression after second transurethral resection in patients with non-muscle-invasive bladder tumor:a single-center factor analysis

目的分析影响经尿道膀胱肿瘤电切(TURBT)肿瘤残留和预后的危险因素,探讨二次电切病理为T1期的患者治疗措施。方法回顾性分析我院收治的所有行二次电切的116例膀胱癌患者的临床资料。利用Logistic回归分析肿瘤残留的危险因素,利用Cox危险因素模型分析无复发生存时间(RFS)及无进展生存时间(PFS)的预测因素。结果二次电切发现肿瘤残留率为28%。影响肿瘤残留的危险因素为肿瘤大小(≥3cm)、肿瘤数量(多个)、首次电切基底缺乏肌层组织以及低年资术者。首次电切基底是否缺乏肌层组织以及是否完成膀胱灌注疗程是RFS的独立预测因素,是否完成膀胱灌注疗程也是PFS的独立预测因素。结论二次电切术后应坚持完成膀胱灌注,二次电切病理为阳性患者较阴性患者预后差,对于二次电切病理为T1患者,坚持膀胱灌注可降低复发风险,延长RFS和PFS。

Objective The risk factors for residual tumor and prognosis after the second transurethral resection of bladder tumor （TURBT）were retrospectively analyzed and the treatment of patients with pT1 bladder tumor found by the second TURBT was explored. Methods The clinical data of 116 patients who underwent the second TURBT were collected. Risk factors for residual tumor were evaluated using logistic regression model. The predictive factors for recurrence-free survival （RFS）and progression-free survival （PFS）were evaluated using Cox proportional hazards model. Results The rate of residual tumor found by the second TURBT was 28%. The risk factors for residual tumor were tumor size （≥3 cm）,number of tumor （〉1 lesion） ,absence of basal muscle tissue in the initial TURBT specimen,and junior surgeons. Whether or not there was basal muscle tissue in the initial TURBT specimen,and whether bladder irrigation was finished were the independent predictive factors for RFS. Whether or not bladder irrigation was finished was an independent predictive factor for PFS. Conclusion After the second TURBT,the patients should finish bladder irrigation. Positive pathology after the second TURBT is associated with poor RFS and PFS. For patients with pT1 pathology after the second TURBT, bladder irrigation can reduce the risk of recurrence and extend RFS and PFS.