肌层浸润性膀胱癌保留膀胱术后复发与进展的相关因素分析
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摘要
目的探讨影响肌层浸润性膀胱癌保留膀胱术后复发与进展的相关因素,为临床选择肌层浸润性膀胱癌患者行保留膀胱手术提供依据。方法回顾性分析获得系统随访的38例行保留膀胱手术的肌层浸润性膀胱癌患者的资料,对性别、年龄、肿瘤数目、肿瘤大小、病理分级、既往复发、手术方式、即刻灌注、静脉化疗等因素进行生存分析,定义复发或进展为终点事件。生存分析运用Kaplan-Meier法,单因素与多因素分析运用Cox回归,采用Log-rank法进行显著性检验。结果随访3~36个月,25例复发(复发率65.8%),17例进展(进展率44.7%)。复发时间(11.6±0.8)个月,中位复发时间11个月,未复发生存时间(19.9±1.5)个月,中位生存时间19个月。进展时间(11.2±1.2)个月,中位进展时间10个月。Cox单因素分析发现,肿瘤数目、肿瘤大小、病理分级、既往复发、静脉化疗均是影响肿瘤复发与进展的因素;Cox多因素分析发现,肿瘤数目(RR=2.968,P=0.004)、病理分级(RR=2.128,P=0.027)是影响肿瘤复发的独立危险因素,肿瘤数目(RR=4.519,P=0.003)、病理分级(RR=3.137,P=0.014)同样是影响肿瘤进展的独立危险因素。结论肿瘤数目、病理分级是影响肌层浸润性膀胱癌保留膀胱术后复发与进展的独立危险因素,临床上尽可能选择肿瘤数目较少、病理分级较低的肌层浸润性膀胱癌患者行保留膀胱手术。
Objective To analyze the factors related to the recurrence and progression of muscle-invasive bladder cancer after bladder-preserving operation. Methods Clinical data of 38 cases with muscle-invasive bladder cancer undergoing bladder-preserving operation were retrospectively analyzed.Sex,age,tumor number,tumor size,grade,previous recurrence,surgical approach,immediate intravesical chemotherapy,intravenous chemotherapy were supposed to be the risk factors.Survival analysis,including univariate analysis and multivariate analysis,was carried out by employing Kaplan-Meier and Cox proportional hazard model. Results Based on 3-36 months of following up,25(65.8%)of 38 cases had recurrence and 17(44.7%)cases had progression.The relapse time was(11.6±0.8)months,the median relapse time was 11 months,the relapse-free survival time was(19.9±1.5)months,the median survival time was 19 months.The time to progression was(11.2±1.2)months and the median time to progression was 10 months.Cox univariate analysis found that tumor number,tumor size,grade,previous recurrence,intravenous chemotherapy were the factors that affected recurrence and progression.Cox multivariate analysis found that tumor number and grade were independent risk factors. Conclusions The tumor number and grade were independent risk factors affected recurrence and progression after bladder-preserving operation for muscle-invasive bladder cancer.
Objective To analyze the factors related to the recurrence and progression of muscle-invasive bladder cancer after bladder-preserving operation. Methods Clinical data of 38 cases with muscle-invasive bladder cancer undergoing bladder-preserving operation were retrospectively analyzed.Sex,age,tumor number,tumor size,grade,previous recurrence,surgical approach,immediate intravesical chemotherapy,intravenous chemotherapy were supposed to be the risk factors.Survival analysis,including univariate analysis and multivariate analysis,was carried out by employing Kaplan-Meier and Cox proportional hazard model. Results Based on 3-36 months of following up,25(65.8%)of 38 cases had recurrence and 17(44.7%)cases had progression.The relapse time was(11.6±0.8)months,the median relapse time was 11 months,the relapse-free survival time was(19.9±1.5)months,the median survival time was 19 months.The time to progression was(11.2±1.2)months and the median time to progression was 10 months.Cox univariate analysis found that tumor number,tumor size,grade,previous recurrence,intravenous chemotherapy were the factors that affected recurrence and progression.Cox multivariate analysis found that tumor number and grade were independent risk factors. Conclusions The tumor number and grade were independent risk factors affected recurrence and progression after bladder-preserving operation for muscle-invasive bladder cancer.
引文
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[12]Braasch MR,Bhle A,O,Donnell MA.Intravesical instillation treatment of non-muscle-invasive bladder cancer[J].Eur Urol Suppl,2009,8(7):549-555.
[13]Sfakianos JP,Kim PH,Hakimi AA,et al.The effect of restaging transurethral resection on recurrence and progression rates in patients with nonmuscle invasive bladder cancer treated with intravesical bacillus Calmette-Guérin[J].J Urol,2014,191(2):341-345.
[14]Palou-Redorta J,Rouprêt M,Gallagher JR,et al.The use of immediate postoperative instillations of intravesical chemotherapy after TURBT of NMIBC among European countries[J].World J Urol,2014,32(2):525-530.
[15]Knoedler JJ,Boorjian SA,Kim SP,et al.Does partial cystectomy compromise oncologic outcomes for patients with bladder cancer compared to radical cystectomy?A matched case-control analysis[J].J Urol,2012,188(4):1115-1119.
[16]李双辉,张志宏,徐勇,等.根治性经尿道膀胱肿瘤电切术加化疗治疗肌层浸润性膀胱癌的疗效分析[J].中华泌尿外科杂志,2012,33(3):215-218.
[17]王勇,钟隆飞,李巧星,等.经尿道膀胱肿瘤电切联合化疗治疗浸润性膀胱癌(附20例报告)[J].现代泌尿生殖肿瘤杂志,2014,6(6):334-336.
[2]Russell CM,Lebastchi AH,Borza T,et al.The role of transurethral resection in trimodal therapy for muscle-invasive bladder cancer[J].Bladder Cancer,2016,2(4):381-394.
[3]赵阳,陈贵平,王华,等.膀胱部分切除术在局限性肌层浸润性膀胱癌治疗中的作用[J].中华泌尿外科杂志,2013,34(7):497-500.
[4]Ramani VA,Maddineni SB,Grey BR,et al.Differential complication rates following radical cystectomy in the irradiated and nonirradiated pelvis[J].Eur Urol,2010,57(6):1058-1063.
[5]Jemal A,Bray F,Center MM,et al.Global cancer statistics[J].CA Cancer J Clin,2011,61(2):69-90.
[6]Lyons MD,Smith AB.Surgical bladder-preserving techniques in the management of muscle-invasive bladder cancer[J].Urol Oncol,2016,34(6):262-270.
[7]Xylinas E,Kent M,Kluth L,et al.Accuracy of the EORTC risk tables and of the CUETO scoring model to predict outcomes in non-muscle-invasive urothelial carcinoma of the bladder[J].Br J Cancer,2013,109(6):1460-1466.
[8]Liu S,Hou J,Zhang H,et al.The evaluation of the risk factors for non-muscle invasive bladder cancer(NMIBC)recurrence after transurethral resection(TURBt)in Chinese population[J].Plos One,2015,10(4):e0123617.
[9]Abdelsalam YM,Mokhtar AA,Kurkar AA,et al.Defining patient selection for prostate-sparing cystectomy in squamous cell carcinoma of the urinary bladder associated with bilharziasis:an overview of 236patients[J].Urology,2011,78(6):1351-1354.
[10]房杰群,黄建生,肖克峰.膀胱部分切除术配合辅助化疗治疗盆腔淋巴结阴性的肌层浸润性膀胱癌临床疗效及其预后影响因素分析[J].国际泌尿系统杂志,2014,34(4):468-471.
[11]Xu T,Zhu Z,Zhang X,et al.Predicting recurrence and progression in Chinese patients with nonmuscle-invasive bladder cancer using EORTC and CUETO scoring models[J].Urology,2013,82(2):387-393.
[12]Braasch MR,Bhle A,O,Donnell MA.Intravesical instillation treatment of non-muscle-invasive bladder cancer[J].Eur Urol Suppl,2009,8(7):549-555.
[13]Sfakianos JP,Kim PH,Hakimi AA,et al.The effect of restaging transurethral resection on recurrence and progression rates in patients with nonmuscle invasive bladder cancer treated with intravesical bacillus Calmette-Guérin[J].J Urol,2014,191(2):341-345.
[14]Palou-Redorta J,Rouprêt M,Gallagher JR,et al.The use of immediate postoperative instillations of intravesical chemotherapy after TURBT of NMIBC among European countries[J].World J Urol,2014,32(2):525-530.
[15]Knoedler JJ,Boorjian SA,Kim SP,et al.Does partial cystectomy compromise oncologic outcomes for patients with bladder cancer compared to radical cystectomy?A matched case-control analysis[J].J Urol,2012,188(4):1115-1119.
[16]李双辉,张志宏,徐勇,等.根治性经尿道膀胱肿瘤电切术加化疗治疗肌层浸润性膀胱癌的疗效分析[J].中华泌尿外科杂志,2012,33(3):215-218.
[17]王勇,钟隆飞,李巧星,等.经尿道膀胱肿瘤电切联合化疗治疗浸润性膀胱癌(附20例报告)[J].现代泌尿生殖肿瘤杂志,2014,6(6):334-336.