EORTC风险量表对非肌层浸润性膀胱癌术后即刻灌注化疗预后判断的研究  

Validation and analysis of the prognostic value of the EORTC risk tables in chinese patients with nonmuscle invasive bladder cancer treated by immediate postoperative intravesical instillation of chemotherapy

作　　者：许天源[1] 朱照伟[1] 钟山[1] 张小华[1] 王先进[1] 张敏光[1] 沈周俊[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院泌尿外科,上海200032

出　　处：《临床泌尿外科杂志》2013年第7期504-508,512,共6页Journal of Clinical Urology

摘　　要：目的:验证和研究欧洲癌症研究与治疗组织(European Organization for Research and Treatment of Cancer,EORTC)风险量表对我国接受术后即刻膀胱灌注化疗的非肌层浸润性膀胱癌(nonmuscle invasive bladder cancer,NMIBC)患者预后判断的效果。方法:回顾性分析2003年5月～2010年12月期间297例接受经尿道膀胱肿瘤电切(transurethral resection of bladder cancer,TURBT)的NMIBC患者的临床病理资料,所有患者均在术后24小时内接受了首次膀胱灌注化疗。按照EORTC量表的评分原则计算出每位患者的复发和进展评分,并根据得分将所有患者进行风险分层。随访各危险组患者术后复发和进展情况,并将分析结果同量表参考值比较。结果:随访时间23～115个月,平均53个月。随访过程中共122例患者(41%)复发,多因素分析显示复发性肿瘤、G2～3级肿瘤和未在TURBT后6小时内进行首次膀胱灌注化疗是复发的独立危险因素;19例患者(6%)术后进展,独立危险因素包括复发性肿瘤、T1期肿瘤、G3期肿瘤和同时存在原位癌。根据EORTC量表进行复发风险分层后,各组间实际复发率差异均有统计学意义(P<0.01);与EORTC量表参考值相比,低危组(0分)1年及5年复发率均低于参考范围;中危患者(1～9分)的1年复发率低于参考范围,而5年复发率与参考范围相近;高危组(10～17分)1年及5年复发率可信区间均包含EORTC量表的参考范围。进展风险分层除低危组(0分)与中低危组(2～6分)间的实际进展率差异无统计学意义(P=0.10)外,其它各组间的差异均有统计学意义(P<0.01);各风险组实际进展率均接近EORTC的参考范围。结论:EORTC量表对于接受术后即刻膀胱灌注化疗的中国NMIBC患者具有预后价值,但低危患者的实际复发率和中危患者的短期实际复发率低于该量表的参考值。Objective： To validate and analyze the prognostic value of the European Organization Research and Treatment of Cancer （EORTC） risk tables in Chinese patients with non-muscle invasive bladder cancer （NMIBC） treated by immediate postoperative instillation of chemotherapy （IPOC）. Method： Retrospective study was performed in 297 NMIBC patients treated with transurethral resection of bladder tumor （TURBT） in our hospital be tween May 2003 and December 2010. All of them received IPOC within 24 hours after TURBT. Scores for recur- rence and progression were calculated based on the risk tables and then all patients were stratified into risk groups according to their scores. Recurrence and progression of each group were surveyed and then compared with the corresponding reference of the risk tables. Result： The mean follow-up duration was 53 months （range： 23-115 months）. Recurrence was observed in 122 （41%） patients; prior recurrence, G23 tumors and receiving IPOC over 6 hours after TURBT were independent risk factors of recurrence according to the multivariate analysis. Nineteen （6%） patients developed into muscle-invasive disease and prior recurrence, T1 tumors, G3 tumors, and presence of concomitant Carcinoma in situ were independent predictor for shorter progression-free interval. The EORTC re- currence risk table stratified our patients into 4 groups with statistically different probabilities of recurrence （P〈0.01）; for low-risk group （score 0）, recurrence probabilities at both 1 and 5 years were lower than the reference range; for patients with intermediate risk （score 1 9）, the 1 year recurrence probability was lower than the reference range whereas the 5-year probability was similar to that; for high risk group （score 10-17）, recurrence probabilities at both 1 and 5 years were similar to the reference value. The progression risk table also stratified our patients into 4 different risk groups except no significant difference was observed between low-risk and in

关 键 词：膀胱肿瘤 非肌层浸润性膀胱癌 膀胱灌注化疗 预后 欧洲癌症研究与治疗评分表 

分 类 号：R737.14[医药卫生—肿瘤]