Correlation factors analysis of tumor residue and recurrence of the second transurethral resection in non-muscle-invasive bladder cancer
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摘要: 目的:分析非肌层浸润性膀胱癌(non-muscular-invasive bladder cancer, NMIBC)首次电切术后肿瘤残余发生率,肿瘤残余及术后复发的相关因素分析,探讨二次电切术(repeat transurethral resection, Re-TUR)对NMIBC的临床意义及需改进措施。方法:回顾性分析我院2014年1月—2019年12月收治的经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor, TURBT)后行Re-TUR的膀胱癌患者的临床病理资料。统计患者Re-TUR后肿瘤残余状态;利用Logistic回归模型分析肿瘤残余的相关因素,利用Cox危险因素模型分析无复发生存期(RFS)的相关因素。应用Kaplan-Meier法来描绘RFS,并用Log-rank检验进行生存比较。结果:共计247例膀胱癌患者接受Re-TUR,病理结果显示肿瘤残余78例(31.6%),平均随访时间22(1~65)个月,随访期间31例(14.7%)患者复发,其中1年复发率为12.8%,3年复发率为14.2%,其中8例(3.8%)复发患者出现疾病进展。Logistic回归分析结果显示肿瘤残余与肿瘤多发(OR=2.12,P=0.035),卫星灶(OR=3.86,P=0),首次电切标本可见肌肉组织(OR=0.48,P=0.047),肿瘤距输尿管开口<2 cm(OR=2.02,P=0.005)显著相关。疾病复发相关因素分析中,Cox单因素分析显示肿瘤残余(HR=4.31,P=0),肿瘤带蒂(HR=0.32,P=0.002),合并原位癌(HR=5.14,P=0.002),肿瘤再发(HR=3.52,P=0.006)和BCG膀胱灌注(HR=0.478,P=0.041)与RFS显著相关,进一步多因素分析结果显示肿瘤残余(HR=3.31,P=0.003)为RFS的独立相关因素。Kaplan-Meier生存分析(P=0 Log-rank)显示肿瘤残余与患者RFS显著相关。结论:膀胱肿瘤首次电切术后存在一定的肿瘤残余,二次电切病理阳性较阴性患者预后差,二次电切可进一步清除残余肿瘤;肿瘤多发,卫星灶,原位癌及肿瘤距输尿管开口<2 cm为肿瘤残余正相关因素,推荐此类患者行二次电切;患者RFS与肿瘤残余、肿瘤带蒂、原位癌、BCG膀胱灌注及肿瘤再发显著相关,其中肿瘤残余为RFS的独立相关因素,肿瘤残余患者较无残余患者RFS明显缩短。
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关键词:
- 膀胱肿瘤 /
- 经尿道膀胱肿瘤电切术 /
- Re-TUR /
- 肿瘤残余 /
- 预后
Abstract: Objective: Residual tumor at repeat transurethral resection(Re-TUR) was not uncommon in non-muscle-invasive bladder cancer(NMIBC). The risk factors for tumor residual and recurrence were investigated to explore the prognostic value of pathological positive after Re-TUR for NMIBC.Methods: The clinicopathological data of patients with bladder cancer who underwent Re-TUR after transurethral resection of bladder tumor(TURBT) in our hospital from January 2014 to December 2019 were retrospectively analyzed. The residual tumor status after Re-TUR was calculated. The correlation factors of tumor residual were analyzed by multivariate logistic regression, and the predictors of recurrence-free survival(RFS) were analyzed by Cox regression models. The Kaplan-Meier method was used to describe RFS and the log-rank test was used for survival comparison.Results: A total of 247 patients with bladder cancer received Re-TUR, and the pathological results after Re-TUR showed tumor residual in 78(31.6%) patients. The mean follow-up time was 22(1-65) months. During the follow-up, 31 patients(14.7%) relapsed, with a 1-year recurrence rate of 12.8% and a 3-year recurrence rate of 14.2%. Logistic regression analysis showed that tumor residual was significantly correlated with multiple tumors(OR=2.12, 95%CI: 1.05-2.46; P=0.035), satellite focus(OR=3.86, 95%CI: 1.87-7.94; P=0), muscle included in the specimen of the first TURBT(OR=0.48, 95%CI: 0.24-0.99; P=0.047), and tumor less than 2 cm away from the ureteral orifice(OR=2.02, 95%CI: 1.01-4.08; P=0.005). Cox univariate analysis showed that tumor residual(HR=4.31, 95%CI: 2.06-9.02; P=0), pedicle tumors(HR=0.32, 95%CI: 0.15-0.67; P=0.002), presence of carcinoma in situ(HR=5.14, 95%CI: 1.78-14.83; P=0.002), intravesical instillation therapy with BCG or other agents(HR=0.478, 95%CI: 0.235-0.969; P=0.041) and previous bladder cancer history(HR=3.52, 95%CI: 1.44-8.60; P=0.006) were significantly correlated with RFS. Further multivariate analysis showed that tumor residual(HR=3.31, 95%CI: 1.51-7.26; P=0.003) was an independent predictor for RFS. Kaplan-Meier survival analysis(P=0 log-rank) showed a significant correlation between tumor residue and RFS.Conclusion: After the initial TURBT, there were some residual tumors, and the prognosis of the patients with positive pathology of Re-TUR was worse than that of the patients with negative pathology. Re-TUR could further remove residual tumors and benefit patients. Re-TUR is recommended for patients with one of tumor residual risk factors, and more specific and close follow-up should be conducted. -
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