二次电切在非肌层浸润性膀胱肿瘤治疗中的意义及相关危险因素分析

Significance of repeated transurethral resection of bladder tumor and analysis of related risk factors

目的对比非肌层浸润性膀胱肿瘤(NMIBC)行经尿道膀胱肿瘤电切术(TURBT)与经尿道膀胱肿瘤二次电切术(Re-TURBT)的术后复发率及进展率,研究NMIBC复发及进展的相关危险因素及二次电切不同手术时机对患者预后的影响。方法采用前瞻性临床随机对照研究,分析进行手术治疗的NMIBC患者95例。按照术前制定的筛选标准,将患者分为TURBT组55例及Re-TURBT组40例。采用KaplanMeier法绘制生存曲线、计算平均生存时间及生存率。单因素分析采用Log-rank检验,多因素分析采用Cox比例风险模型。结果 (1) Re-TURBT组在术后复发率及进展率方面均优于TURBT组,TURBT组及Re-TURBT组术后平均无复发生存时间分别为16. 94个月vs 21. 86个月(P <0. 05),术后12个月无复发生存率(RFS)分别为:65. 8%vs 86. 9%,平均无进展生存时间分别为20. 56个月vs 23. 73个月(P <0. 05),术后18个月无进展生存率(PFS)分别为73. 7%vs86. 3%(P <0. 05);(2)单因素分析结果提示:组别、肿瘤大小、临床分期及病理分级是肿瘤复发及进展的影响因素;多因素分析结果显示:组别、肿瘤大小、病理分级为肿瘤复发的独立影响因素;组别、肿瘤大小、临床分期为肿瘤进展的独立影响因素;(3) Re-TURBT组患者根据两次手术间隔时间长短分为两组:≤6周和> 6周,两组患者之间的平均无复发生存时间分别为24. 00个月vs 16. 93个月(P <0. 05),差异具有统计学意义。两组患者间无进展生存时间分别为24. 00个月vs 21. 00个月(P> 0. 05),差异无统计学意义。结论二次电切可以显著降低术后膀胱癌复发及进展的风险。对于体积较大(≥30 mm),分期较高(≥T1期),病理级别为高级别的肿瘤应行Re-TURBT以降低肿瘤复发率及进展率。行二次电切手术的患者,第二次手术应在第一次手术后的6周内进行。

Objective To compare the recurrence rate and progression rate of transurethral resection of bladder tumor(TURBT)and repeated transurethral resection of bladder tumor(Re-TURBT)with non-muscle invasive bladder cancer.To investigate the risk factors associated with the recurrence and progression of NMIBC,and the impact of different timing of Re-TURBT on the prognosis of patients.Methods Prospective clinical randomized controlled study was conducted.95 cases of NMIBC patients were analyzed.According to preoperative screening criteria,the patients were divided into TURBT group 55 cases and Re-TURBT group 40 cases.The survival curve was drawn by Kaplan-Meier method,and the average survival time and survival rate were calculated.Logistic rank test was used in univariate analysis.Cox regression model was used in multivariate analysis.Results The recurrence rate and progression rate of Re-TURBT were better than those in TURBT group.The average recurrence-free survival time of TURBT group and Re-TURBT group were 16.94 months vs 21.86 months(P<0.05),and recurrence-free survival rate(RFS)at 12 months was 65.8%vs 86.9%(P<0.05),respectively.The mean progression-free survival rate(PFS)at 18 months was 73.7%vs 86.3%(P<0.05),respectively.The mean progression-free survival time was 20.56 months vs 23.73 months(P<0.05).The result of univariate analysis indicated that the group,tumor size,clinical stage and pathological grade were related factors of tumor recurrence and progression.Multivariate analysis showed that the group,tumor size and pathological grade were the independent related factors of tumor recurrence;Group,tumor size,clinical stage of tumor were the independent related factors of tumor progression.The patients in Re-TURBT group were divided into two groups according to the length of the interval between TURBT and Re-TURBT:≥6 weeks and<6 weeks.The mean recurrence-free survival time was 24.00 months vs 16.93 months(P<0.05),the difference was statistically significant.The progression-free survival time between the two groups were 24.00 months vs 21.00 months(P>0.05),with no significant difference.Conclusion Re-TURBT can reduce the risk of recurrence and progression of bladder cancer.Re-TURBT should be used to reduce the tumor recurrence rate and progression rate in patients with large tumor size(≥30 mm),high clinical stage(≥T1 stage)and high pathological grade.In patients undergoing Re-TURBT,the second surgery should be performed within 6 weeks of the first surgery.