低危非肌层浸润性膀胱癌的复发与随访策略  

Recurrence and Follow-up Strategy of Low-risk Non Muscle Invasive Bladder Tumor

作　　者：张申平 刘承浩 魏伟[1] 刘建光[1] 姜兴金[1] 杨进益[1] ZHANG Shenping;LIU Chenghao;WEI Wei;LIU Jianguang;JIANG Xingjin;YANG Jinyi(Department of Urology, Dalian Friendship Hospital, Dalian 116000, China)

机构地区：[1]大连市友谊医院泌尿外科,116000

出　　处：《现代泌尿生殖肿瘤杂志》2020年第4期201-205,共5页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的通过对低危非肌层浸润性膀胱癌(NMIBC)术后复发规律的研究,探讨术后随访复查策略。方法选取2002年9月至2016年9月大连市友谊医院收治的312例NMIBC患者为研究对象。患者平均年龄60.7岁,均接受经尿道膀胱肿瘤电切术(TURBT),肿瘤均为原发、单发、直径<3 cm,术后病理均为TaG1(乳头状低级别),均不伴发有原位癌(CIS),术后均行膀胱灌注化疗。随访包括术后3个月、12个月的膀胱镜检查,之后每年一次,持续3~5年,以后改为无限期行年度经腹超声检查。根据肿瘤大小不同将低危NMIBC患者分为两组进行随访。结果254例(81.4%)得到完整随访资料,中位随访年限为9.5年,其中有81例(31.9%)出现肿瘤复发。101例(39.8%)患者肿瘤大小≤1 cm,这些患者比肿瘤大小1.1~3.0 cm的患者年轻(63.4岁vs.67.5岁,P=0.027),5年无复发生存率明显增高(90%vs.68%,P<0.001)。肿瘤大小≤1 cm的患者肿瘤平均复发时间为5.6年,而肿瘤大小1.1~3.0 cm的患者肿瘤平均复发时间为2.4年(P=0.028)。38.1%的小肿瘤在5年以内复发,而大小1.1~3.0 cm肿瘤患者有73.3%在5年以内复发。结论低危NMIBC患者群体是非均质的,具有不同的生物学行为。根据肿瘤大小可以进一步分层,肿瘤直径≤1 cm的患者,复发的风险更低、复发发生的时间更晚。可以把这类病人归为“极低危”组群体,为提高患者随访复查的依从性,对这一群体的随访可以在术后3个月的首次膀胱镜检查后适当减少膀胱镜检查频率。对于低危NMIBC患者,根据肿瘤大小进行膀胱镜检查频率的差异化随访,提高了患者随访复查的依从性。Objective To study the recurrence of low-risk non-muscle invasive bladder cancer(NMIBC),and to explore the strategy of follow-up and reexamination.Methods From September 2002 to September 2016,312 patients with NMIBC(average age 60.7 years)in our hospital underwent transurethral resection of bladder tumor(TURBT).The tumors were all primary,single and less than 3cm in diameter.The postoperative pathology was TG(papillary low grade),without cancer in situ(CIS),and all patients received intravesical chemotherapy.The follow-up included cystoscopy at 3 months and 12 months after operation,and then once a year for 3-5 years.After that,annual transabdominal ultrasonography was performed indefinitely.Patients with low-risk NMIBC were divided into two groups according to the tumor size.Results Two hundred and fifty-four cases(81.4%)got complete follow-up data,During the median follow-up period of 9.5 years,81 cases(31.9%)had tumor recurrence.One hundred and one patients(39.8%)with tumor size≤1 cm were younger than those with tumor size of 1.1-3.0 cm(63.4 vs.67.5 years,P=0.027).The 5-year recurrence free survival rate was significantly higher(90%vs.68%,P<0.001),The average recurrence time of patients with tumor size≤1 cm was 5.6 years,while that of patients with tumor size of 1.1-3.0 cm was 2.4 years(P=0.028).Recurrence occurred in 38.1%of small tumor recurrence occurred within 5 years,while 73.3%of patients with tumor size of 1.1-3.0 cm occurred within 5 years.Conclusions Low-risk NMIBC patients are heterogeneous and have different biological behaviors.Patients with tumor diameter less than or equal to 1 cm had lower risk of recurrence and later recurrence.This kind of patients can be classified as"very low risk"group.In order to improve the compliance of follow-up review,the frequency of cystoscopy can be appropriately reduced after the first cystoscopy 3 months after operation.For patients with low-risk NMIBC,differential follow-up of cystoscopy frequency according to tumor size can improve the compliance of follow-

关 键 词：膀胱癌 低级别膀胱癌 复发 随访 

分 类 号：R73[医药卫生—肿瘤]