基于膀胱癌二次电切术后病理灌注化疗方案的改良研究

Investigation of pathological perfusion chemotherapy after repeated transurethral resection of bladder cancer

目的探讨继续首次经尿道膀胱肿瘤电切术(TURBT)后灌注与重新开始新一轮灌注周期对膀胱肿瘤二次电切术(re-TURBT)后病理结果中含有残余肿瘤成分的膀胱癌患者的治疗效果比较。方法回顾性分析2014年至2022年徐州医科大学附属医院就诊的82例非肌层浸润性膀胱癌患者的临床资料。根据灌注方案的不同将患者分为重新灌注组(重新开始新一轮灌注化疗方案,47例)和继续灌注组(继续首次膀胱肿瘤电切术后灌注化疗,35例)。所有接受二次膀胱肿瘤电切术的患者每3个月进行一次膀胱镜检和影像学检查,分析两组患者的膀胱肿瘤的复发情况及影响因素。结果重新灌注组和继续灌注组的中位随访时间分别为68和44个月,复发率分别为15%和60%。Kaplan-Meier生存曲线结果显示,重新灌注组的无复发生存率(RFS)高于继续灌注组(P<0.001)。单因素Cox回归分析结果显示,BMI、灌注方案及膀胱肿瘤二次电切术后病理分期是膀胱癌复发的影响因素(均P<0.05)。多因素Cox回归分析结果显示,灌注方案及术后病理分期均是膀胱癌复发的重要危险因素(均P<0.05)。结论在二次电切病理结果中提示有肿瘤成分存在时,相比于继续首次电切术后灌注方案的患者,重新开始新一轮灌注化疗方案患者的RFS更高,且复发率更低,因此对于接受re-TURBT术后病理阳性的患者进行重新灌注周期可能有助于改善其预后。

ObjectiveTo explore the efficacy of continuing initial transurethral resection of bladder cancer(TURBT)perfusion and restarting a new cycle of perfusion in bladder cancer patients with residual tumor components in repeated transurethral resection of bladder cancer(re-TURBT)pathologic findings.MethodsThe clinical data of 82 patients with non-muscular invasive bladder cancer treated in the Affiliated Hospital of Xuzhou Medical University from 2014 to 2022 were retrospectively analyzed.According to the different perfusion regimen,the patients were divided into reperfusion group(restart a new round of perfusion chemotherapy regimen,47 cases)and continued perfusion group(continue perfusion chemotherapy after the first electroresection of bladder tumor,35 cases).All patients who underwent secondary resection of bladder tumors underwent cystoscopy and imaging every 3 months to determine the recurrence of bladder tumors.ResultsMedian follow-up time for the reperfusion group and the continued perfusion group were 68 and 44 months,respectively.The recurrence rates were 15%and 60%,respectively.The Kaplan-Meier survival curve showed that the RFS of the reperfusion group was significantly longer than that of the reperfusion group(P<0.001).The results of univariate Cox regression analysis showed that BMI,perfusion regimen and pathological stage after secondary resection of bladder tumor were the influencing factors for bladder cancer recurrence(all P<0.05).Multivariate Cox regression analysis showed that perfusion scheme and secondary pathological stage were important risk factors for bladder cancer recurrence(all P<0.05).ConclusionsWhen the pathological results of secondary electrotomy indicated the presence of tumor components,patients who resumed a new round of perfusion chemotherapy regimen had higher RFS and lower recurrence rate than those who continued the perfusion regimen after the first electrotomy.Therefore,reperfusion cycles for patients receiving re-TURBT with positive postoperative pathology may help improve their prognosis.