非肌层浸润膀胱癌二次电切的临床意义及肿瘤复发的危险因素分析

The Significance of Repeated Transurethral Resection for Non-Muscle Invasive Bladder Cancer and Analysis of Risk Factors in Recurrence of Non-Muscle Invasive Bladder Cancer

目的探讨非肌层浸润膀胱癌(NMIBC)患者行二次电切手术的意义,以及影响肿瘤复发的临床病理因素。方法收集2013年5月—2020年3月接受二次电切的NMIBC患者103例,回顾性分析患者的临床和病理资料及术后初次复发时间,通过χ^(2)检验、Ridit分析、Log-rank生存分析及COX回归分析影响肿瘤复发的危险因素。结果二次电切术后肿瘤残留阳性率为28.2%(29/103),其中Ta期阳性率为23.1%(6/26),T_(1)期为29.9%(23/77);单发肿瘤二次电切阳性率为30.2%(13/43),多发肿瘤为26.7%(16/60);2例初次电切为Ta期的病例,二次电切上升为T_(1)期。随访结束时,共有18例复发,其中3例进展为肌层浸润膀胱癌,已行根治手术。统计学分析显示,肿瘤多发是导致复发的危险因素。结论二次电切有助于清除NMIBC患者初次电切术后的残留肿瘤,从而降低肿瘤的复发和进展;肿瘤多发是肿瘤复发的危险因素。

Objective To retrospectively analyze risk factors of bladder cancer and recurrence rate after repeated transurethral resection of non-muscle invasive bladder tumor(NMIBC).Methods The clinical and pathological data of 103 NMIBC patients who received the repeated transurethral resection(Re-TURBT)were collected.The first postoperative recurrence were also documented.Chi-square test,Ridit analysis,Log-rank survival analysis and COX regression analysis were used to analyze the risk factors for tumor recurrence.Results Tumor residual rate after Re-TURBT was 28.2%(29/103).The positive rate of Ta and T_(1) stage was 23.1%(6/26)and 29.9%(23/77),respectively.The positive rate of single tumor and multiple tumors was 30.2%(13/43)and 26.7%(16/60),respectively.2 Ta cases in the primary operation were corrected to T_(1) after Re-TURBT.At the end of follow-up,a total of 18 patients had recurrence,of which 3 patients developed muscle invasive bladder cancer and underwent radical surgery.Statistical analysis showed that multiple-tumor was risk factor for recurrence.Conclusion Re-TURBT is helpful to remove the residual tumor after primary resection in patients with NMIBC,thus reducing the recurrence and progression of tumor.Multiple-tumor is a risk factor for tumor recurrence in NMIBC.