非肌层浸润性膀胱癌的复发及进展风险因素回顾分析  

Exploring the risk factors of recurrence and progression in 188 patients with non-muscle invasive bladder cancer by retrospectively analysis

作　　者：胡明球[1] 李宁忱[1] 金石华[1] 果宏峰[1] 柳金顺[1] 孙国锋[1] 王义[1] 那彦群[1] 

机构地区：[1]北京大学首钢医院吴阶平泌尿外科医学中心,100144

出　　处：《中华临床医师杂志（电子版）》2015年第24期5-9,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的 探讨分析影响非肌层浸润性膀胱癌复发、进展的风险因素及其临床意义.方法 回顾分析北京大学首钢医院2007 年1 月至2013 年12 月收治的非肌层浸润性膀胱癌患者的全部病例资料,对性别、年龄、肿瘤大小、肿瘤数目、肿瘤分级、肿瘤分期、既往复发频率、是否合并原位癌及术后膀胱灌注等因素进行生存分析,定义复发或进展为终点事件,运用Log-Rank 检验,Kaplan-Meier 法单因素分析比较各因素无病生存率差异,Cox 比例风险回归模型多因素分析复发、进展的独立风险因素.结果 共有188 例非肌层浸润性膀胱癌患者纳入研究,就诊时平均年龄67.3岁,男∶女=5.9∶1,随访时间8～134 个月,复发98 例（总复发率52.1%）,进展27 例（总进展率14.4%）.单因素分析发现,肿瘤大小、数目、分级、分期及既往复发次数与复发相关有统计学意义（均P〈0.05）,原位癌、肿瘤大小、分级、分期及既往复发次数与进展相关,有统计学意义（均P〈0.05）.Cox 回归模型多因素分析发现,肿瘤数目为复发的独立风险因素（风险比HR=1.81）;原位癌、肿瘤大小、肿瘤分级及既往1 年复发次数为疾病进展的独立风险因素（均P〈0.05）,分别HR=3.54、HR=3.22、HR=3.42、HR=2.73.结论 肿瘤数目是非肌层浸润性膀胱癌复发的独立风险因素,肿瘤大小、分级及既往复发频率则显著影响着非肌层浸润性膀胱癌的进展.ObjectiveTo explore the risk factors of recurrence and progression of non-muscle invasive bladder cancer (NMIBC) and determine their clinic value.Methods The complete individual in-patients data of all patients with NMIBC from Jan. 1, 2007 to Dec. 31, 2013 in single center was performed retrospectively. The gender, age, tumor size, tumor number, tumor grade, tumor stage, carcinoma in situ, prior recurrence rate and intravesical instillation 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, respectively.Results Totally 188 patients with NMIBC were studied, with mean age of 67.3 years old at presentation, male∶female=5.9∶1. Based on 8-134 months of following up, 98(52.1%) of 188 caseshad recurrence and 27(14.4%) of 188 cases had progression. The univariate analysis indicated that tumor size, number, grade and stage and prior recurrence rate were significantly associated with the recurrence of NMIBC (allP<0.05), and carcinoma in situ, tumor grade, size, stage prior recurrence rate were significantly associated with the progression (all P<0.05). The Cox multivariate analysis demonstrated that tumor number was the independent risk factor for recurrence with hazard rate of 1.81, and carcinoma in situ, tumor size, grade and prior recurrence rate were the independent risk factors for progression with hazard rate of 3.54, 3.22, 3.42 and 2.73, respectively. Conclusion The number of tumor was the independent risk factor for recurrence of NMIBC, as well&nbsp;carcinoma in situ, tumor size, grade and prior recurrence rate significantly influenced the progression.

关 键 词：膀胱肿瘤 复发 进展 风险因素 

分 类 号：R737.14[医药卫生—肿瘤]