选择性膀胱部分切除术治疗浸润性膀胱癌的多因素生存分析  

Multi-factor Survival Analysis of Selective Partial Cystectomy for Muscle-invasive Bladder Cancer

作　　者：惠鹏宇[1] 李振华[1] 于秀月[1] 高小林[1] 李白[1] 孔垂泽[1] 

机构地区：[1]中国医科大学附属第一医院泌尿外科,沈阳110001

出　　处：《中国医科大学学报》2013年第9期821-824,共4页Journal of China Medical University

摘　　要：目的 总结选择性膀胱部分切除术加膀胱灌注化疗治疗肌层浸润性膀胱癌的经验,探讨影响预后的因素.方法 回顾性分析86例行膀胱部分切除术加膀胱灌注化疗的膀胱癌患者（pT2期84.9％,pT3期15.1％）,应用Kaplan-Meier法计算生存率,采用Cox模型对患者的随访资料进行多因素生存分析.结果 经过中位随访46.5（11～93）个月,5年总生存率、5年癌特异性生存率以及5年无复发生存率分别为65％、73％和54％,经多因素分析,既往有浅表膀胱癌史（RR=2.98,95％CI：1.27～7.00,P=0.012）、肿瘤多发（RR=2.27,95％CI：1.12～4.60,P=0.023）以及肿瘤直径＞5 cm（RR=2.91,95％CI：1.39～6.12,P=0.005）是影响膀胱癌术后复发的重要因素,然而只有肿瘤多发（RR=3.41,95％ CI：1.38～8.44,P=0.008）与肿瘤直径＞5 cm（RR=3.37,95％ CI：1.27～8.92,P=0.015）影响5年癌特异性生存率.结论 选择性膀胱部分切除术加膀胱灌注化疗并没有降低肌层浸润性膀胱癌术后生存率,是一种可行的保留膀胱术式.浅表膀胱癌史、肿瘤多发及肿瘤直径＞5 cm是影响复发和预后的重要因素.Objective To summarize our institutional experience of selective partial cystectomy combined with urinary bladder irrigation chemotherapy for the treatment of muscle-invasive bladder cancer and to explore the factors affecting prognosis of patients.Methods A retrospective analysis was performed on 86 patients with muscle-invasive bladder cancer （pT2 84.9％,pT3 15.1％） who had undergone partial cystectomy,followed by intravesical instillation chemotherapy in our institution.The survival rate was calculated by the Kaplan-Meier method.The follow-up information was analyzed using the Cox model multivariate survival analysis were performed to evaluate the outcome.Results At median follow-up of 46.5 months （range 11-93 months）,the 5-year overall survival rate,caner specific survival rate and recurrence-free survival rate were 65％,73％ and 54％,respectively.Through multivariate analysis,the history of prior superficial transitional cell carcinoma （RR=2.98,95％CI：1.27-7.00,P =0.012）,multifoeality （RR=2.27,95％CI：1.12-4.60,P =0.023） and tumor size ＞ 5 cm （RR=2.91,95％CI：1.39-6.12,P =0.005） were important factors associated with postoperative recurrence of bladder cancer,however,only multifocality （RR=3.41,95％CI：1.38-8.44,P =0.008） and tumor size ＞5 cm （RR=3.37,95％CI：1.27-8.92,P =0.015） were associated with 5-year cancer specific survival rate.Conclusion Partial cystectomy combined with intravesical instillation chemotherapy cannot reduce the postoperative survival rate of muscle-invasive bladder cancer,and is a reliable bladder-sparing approach.Prior superficial transitional cell carcinoma,multifocality and tumor size ＞5 cm are vital factors for prognosis and survival.

关 键 词：膀胱肿瘤 癌 膀胱部分切除术 预后 

分 类 号：R699.5[医药卫生—泌尿科学]