非肌层浸润膀胱尿路上皮癌二次电切术的临床疗效及意义

的国内膀胱尿路上皮癌在泌尿系恶性肿瘤中较常见，其临床特点是多发和高复发率。文章探讨非肌层浸润膀胱尿路上皮癌术后二次电切预防肿瘤复发的临床疗效。方法收集南京军区南京总医院2005年2月至2010年10月期间收治的非肌层浸润性膀胱尿路上皮癌患者84例，其中38例经尿道膀胱肿瘤电切术（transurethralresectionofbladdertumor，TURBT）后4—6周入院行再次电切术（Re—TURBT），46例未行Re—TURBT，比较2组患者肿瘤复发及进展情况。结果38例患者行Re—TURBT中发现残存肿瘤15例（39．5％），残余肿瘤与原发肿瘤大小、数目、分级相关。平均随访26个月后，行Re．TURBT患者较未行Re—TURBT患者的肿瘤复发率（18．4％嬲47．8％）及进展肌层浸润性肿瘤率（5．3％椰23．9％）均显著降低（P〈0．05）。结论非肌层浸润膀胱尿路上皮癌Re—TURBT可有效减少肿瘤复发，延缓肿瘤进展。

非肌层浸润性膀胱癌患者二次经尿道膀胱肿瘤摩西钬激光切除术的临床意义

目的探讨非肌层浸润性膀胱癌患者二次经尿道膀胱肿瘤摩西钬激光切除术的临床有效性。方法选取2018年3月—2019年8月徐州市肿瘤医院和大连医科大学附属第二医院61例行二次经尿道膀胱肿瘤切除术患者,依据手术方式不同,分为摩西钬激光组35例和经尿道膀胱肿瘤电切组(TURBT组)26例。比较两组患者手术时间、术中出血量、膀胱冲洗次数、病理结果准确率、术后随访期复发率。结果61例患者均成功完成手术。两组患者闭孔神经反射发生率比较,差异有统计学意义(P<0.05);两组患者手术时间、保留导尿时间、住院时间、膀胱冲洗次数比较,差异无统计学意义(P>0.05)。摩西钬激光组有33例符合病理分期要求,TURBT组10例符合。两组患者病理诊断准确率比较,差异有统计学意义(P<0.05)。所有患者术后随访时间3~14个月,平均(10.0±2.4)个月。摩西钬激光组肿瘤复发3例(8.6%,3/35),TURBT组复发2例(7.7%,2/26),差异无统计学意义(P>0.05)。结论经尿道摩西钬激光术应用于二次经尿道膀胱肿瘤切除术,手术安全、有效,切除标本满足病理分期要求。

经尿道膀胱尿路上皮肿瘤二次电切临床分析

目的探索经膀胱尿路上皮肿瘤二次电切对减少经尿道膀胱尿路上皮肿瘤电切术(TURBT)术后复发率及改善预后的临床意义。方法分析我院TURBT术后确诊为非肌层浸润性膀胱癌患者157例,其中单次电切组109例,二次电切组48例。所有患者均随访2年,对比两组复发率及各组病理分级、临床分期情况。结果复发患者主要为T1期及高级别尿路上皮癌,2例患者在二次电切后纠正病理诊断。二次电切组复发率低于单次电切组(P<0.05)。结论膀胱肿瘤二次电切可进一步明确肿瘤分期,降低高危膀胱癌患者的复发率、延缓进展、改善预后。临床应用时应严格把握二次电切的手术指针,避免过度治疗。

Did the Scientific Innovations in the Management of Non-Muscle Invasive Bladder Cancer Patients Improve the Outcome during the Last 2 Decades?

Objectives: Previous reviews reported the outcome of each scientific modality in the management of T1 high-grade bladder cancer. The objective of this review is to assess and evaluate the available scientific modalities used during the last two decades and determine whether they were able to improve the clinical outcome. Literature Search Methodology: A systematic literature review was conducted from 2000-2020 using PubMed, Medline, Embase, and other database sites looking at randomized controlled trials (RCTs), clinical trials, research, review articles, and original articles addressing the different scientific modalities used to diagnose and manage patients with non-muscle invasive Bladder cancer (NMIBC)during the last 2 decades. More than 573 studies were retrieved following the preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and PICOS criteria (Population, Intervention, Comparators, Outcomes, and Study design). Only 85 articles were selected for review including 19 prospective trials, 44 RCTs, original articles, research articles, one review article, and clinical trials—Retrospective studies were excluded to limit bias as much as possible in the analysis. Results: Randomized controlled trials (RCTs) have become the gold standard for evaluating the efficacy of new treatments. They are considered the highest standard of evidence-based medicine and are the method of choice. Overall, we selected 85 studies for review, among them 63 prospective trials and RCTs, with a total of 21,895 patients, published between 2000 and 2020. Previously conducted studies have shown that identifying rare histological types with poor prognoses can help improve outcomes, mainly the plasmacytoid type. Many articles addressed the role of biomarkers in the early identification of patients with NMIBC for recurrence and progression—P-cadherin expression and others were used to predict recurrence and/or progression with promising results. Despite the need for modifications, risk stratification is an important tool that should be used to improve the outcome of patients with NMIBC. Some found that fluorescence diagnostic cystoscopy (FDC) and Photodynamic diagnosis (PDD) improved recurrence-free survival but not progression and outcome. All authors agree that intravesical BCG is the most effective therapy that changes the course of high-grade T1 mainly progression. Re-TURBT has become one of the recommendations of international societies, but its potential effect on survival improvement is debatable. Most of the articles showed the advantages of early cystectomy in NMIBC but all agree that the selection criteria must be clearly defined. Conclusions: This review analyzed the outcomes provided by the scientific advances in the field of management of NMIBC patients in the last two decades. Patients with T1 bladder cancer have variable outcomes because of tumor heterogeneity and clinical staging. Despite the great development in the field of diagnosis, risk stratification, and management, further large studies are mostly needed to better elucidate this subset of patients and avoid over and under-treatment.

二次电切术治疗非肌层浸润膀胱尿路上皮癌的临床价值

目的探讨非肌层浸润膀胱尿路上皮癌二次电切术的临床价值。方法将60例非肌层浸润膀胱尿路上皮癌患者随机分为观察组和对照组2组,每组30例,均给予尿道电切术,观察组行二次电切术。比较2组复发情况,并对比首次电切与二次电切的病理结果。结果观察组复发4例(13.3%),出现复发时间(6.3±1.2)个月,其中原电切部位复发1例(3.3%),其他部位复发3例(10.0%),单发1例,多发2例。对照组复发13例(43.3%),出现复发时间(2.4±0.9)个月,其中原电切部位复发7例(23.3%),其他部位复发6例(20.0%),单发4例,多发2例。以上差异具有统计学意义(P<0.05)。观察组初次电切的病理结果显示,Ta期4例(13.3%),T1期26例(86.7%)。二次电切病理结果为Ta期2例(6.7%),T1期19例(63.3%),T2期9例(30.0%)。1例Ta期升为T1期,1例Ta期升为T2期,8例T1期升为T2期。以上差异均有统计学意义(P<0.05)。结论二次电切术能够有效降低非肌层浸润膀胱尿路上皮癌的复发率,同时对纠正病理结果具有重要临床价值。

二次TURBT联合表柔比星、吉西他滨序贯膀胱灌注治疗T_1期高危膀胱癌的临床疗效

目的：评价二次TURBT联合表柔比星（EPI）与吉西他滨（GEM）序贯膀胱灌注治疗T1期高危膀胱癌的安全性及有效性。方法：选取初次行TURBT治疗的病理分型为T1期高危（G2、G3）膀胱尿路上皮癌患者56例,随机分为三组。EPI组17例,给予EPI50mg膀胱灌注,每周1次共6次;GEM组19例,给予GEM1 000mg膀胱灌注,每周1次共6次;EPI＋GEM组20例,给予EPI50mg、GEM1 000mg膀胱灌注,每周1次共6次。三组术后6周均采用二次TURBT治疗,比较三组的病理分级、临床分期改变及灌注化疗不良反应的差异。随访周期12~24个月,比较三组无复发生存率及进展率的变化。结果：EPI组、GEM组、EPI＋GEM组病理分级下降率分别为35.3%（6/17）、36.8%（7/19）及45%（9/20）,EPI＋GEM组明显高于其他两组,差异有统计学意义（P〈0.05）。EPI组、GEM组、EPI＋GEM组不良反应发生率为11.8%、10.4%、10.0%,差异无统计学意义（P〉0.05）。2年肿瘤无复发生存率EPI组、GEM组、EPI＋GEM组为70.6%（12/17）、73.7%（14/19）、80.0%（16/20）,EPI＋GEM组明显高于其他两组,差异有统计学意义（P〈0.05）。EPI组、GEM组、EPI＋GEM组膀胱癌进展率分别为5.9%、5.2%、5.0%,各组进展率差异无统计学意义（P〉0.05）。结论：对T1期高危膀胱尿路上皮癌患者采用二次TURBT术联合EPI、GEM序贯膀胱灌注化疗,术后病理分级下降,2年复发率降低,较单用EPI及GEM具有较好的临床疗效,但不能改变膀胱癌的进展。