EAU肿瘤危险评分表对初发非肌层浸润性膀胱肿瘤预后效力的前瞻性对照研究  

Effectiveness of EAU guideline criteria on prognosis of primary non-muscle invasive blabber cancer:aprospective case-control study

作　　者：张心如[1] 鲁文龙[1] 朱卫东[1] 冯超[1] 司捷旻[1] 李超[1] 郭辉[1] 宋鲁杰[1] 

机构地区：[1]上海交通大学附属第六人民医院泌尿外科,上海200233

出　　处：《临床泌尿外科杂志》2015年第6期505-509,共5页Journal of Clinical Urology

摘　　要：目的：探讨欧洲泌尿外科协会（EAU）推荐的肿瘤复发进展危险评分表（EAU危险评分表）对初发非肌层浸润性膀胱肿瘤（NMIBC）的预后效力。方法：收集2006年1月～2010年12月我院连续收治的552例NMIBC患者,分为初发肿瘤组与复发肿瘤组,分别根据EAU推荐方式予以评分,并根据EAU评分表推荐的肿瘤危险级别对两治疗组患者进行分层,术后膀胱腔内蒽环类药物规律灌注化疗并膀胱镜随访,观察术后肿瘤复发及进展情况。结果：初发肿瘤组292例,复发肿瘤组260例,组间肿瘤特性差异无统计学意义。肿瘤复发评分初发肿瘤组（0～11）分,平均（3.50±2.83）分;复发肿瘤组（2～15）分,平均（4.93±2.95）分,P〈0.01。肿瘤进展危险评分,初发肿瘤组（3.21±3.57）分,复发肿瘤组（4.15±3.25）分,P=0.001。随访2～90个月,266例（48.2%）肿瘤复发,初发肿瘤组131例（44.9%）,复发肿瘤组135例（51.9%）。1年内初发肿瘤组91例（31.2%）肿瘤复发,复发肿瘤组70例（26.9%）复发。分层显示初发肿瘤组中低危及中高危患者的复发率明显高于复发肿瘤组（中低危28.6%vs 15.2%,P=0.008;中高危52.9%vs 37.8%,P=0.035）。共有36例肿瘤进展,其中初发肿瘤组17例,复发肿瘤组19例。结论：EAU风险评分对于初发NMIBC的预测效力仍有值得改进之处,而对于复发肿瘤的预后效力较高。其次,本组肿瘤进展率高于EAU风险评分系统的可信区间,应引起重视。Objective：To evaluate the effectiveness of EAU guideline criteria on prognosis of primary nonmuscle invasive bladder cancer（NMIBC）.Method：We collected the clinical data of 552 NMIBC consecutive cases treated in our hospital from Jan.2006 to Dec.2010.After we grouped the patients as primary group and recurrence group,we also followed the guideline of EAU to score our patients risk for tumor recurrence and progression,then stratify our data into four risk stratifications,which were low risk,intermediate low risk,intermediate high risk and high risk.All of the patients accepted regular bladder instillation with anthracycline and postoperative cystoscopy.Result：There were 292 patients in primary group and 260 patients in recurrence group.The recurrence score in primary group was 0-11（mean,3.50±2.83）,while in recurrence group it was 2-15（mean,4.93±2.95）,P〈0.01.The progression score in primary group was（3.21±3.57）,comparing with（4.15±3.25）in recurrence group,P =0.001.After 2-90 months follow-up period,266 tumor recurrences（48.2%）were detected including 131（44.9%）in primary group and 135（51.9%）in recurrence group.Moreover,91 recurrence cases（31.2%）were found one year postoperatively in primary group while 70cases（26.9%）were found in recurrence group.Stratification analysis showed the recurrence rate of patients with intermediate low and high risk in primary was statistically significant higher than that in recurrence group（intermediate low tumors：28.6% vs.15.2%,P =0.008;intermediate high tumors：52.9% vs.37.8%,P =0.035）.Tumor progression were found in 36 patients during the follow-up period,and 17 were in primary group and 19 were in recurrence group.Conclusion：It is necessary to modify EAU guideline criteria to evaluate prognosis of primary NMIBC.However,it has higher effectiveness of evaluating prognosis of recurrent NMIBC.It should be paid more attention to the fact that tumor progression rate in our study is relatively higher than EAU recommended range.

关 键 词：膀胱肿瘤 非肌层浸润性 预后 肿瘤危险因素 肿瘤复发 肿瘤进展 EORTC肿瘤危险因素评分 

分 类 号：R737.14[医药卫生—肿瘤]