二次切除对经尿道整块切除的高危非肌层浸润性膀胱癌患者预后的影响  

Impact of Re-resection on the Prognosis of Patients with High-risk Non-muscle Invasive Bladder Cancer Who Underwent En Bloc Tran-surethral Resection

作　　者：许生 曹鹏 吴挺明 陈化磊[1] 胡鑫明[1] 徐磊[1] 吴淑龄 古军[1] 车宪平[1] Xu Sheng;Cao Peng;Wu Tingming(Department of Urology,The Second Affiliated Hospital of Hainan Medical University,Hainan 570311,China)

机构地区：[1]海南医学院第二附属医院泌尿外科,海口570311

出　　处：《医学研究杂志》2021年第9期77-80,共4页Journal of Medical Research

基　　金：海南省自然科学基金资助项目(819MS127)。

摘　　要：目的比较经尿道整块切除的高危非肌层浸润性膀胱癌患者术后6周内有无二次切除对患者预后的影响。方法回顾性分析2015年1月~2017年10月在海南医学院第二附属医院行经尿道整块切除的43例高危非肌层浸润性膀胱癌患者的临床资料,其中患者年龄45~78岁,平均年龄66.8岁;男性32例,女性11例;单发肿瘤18例,多发肿瘤25例;T_(a)期肿瘤12例,T_(1)期肿瘤31例;低级别肿瘤8例,高级别肿瘤35例。根据首次手术后6周内有无行二次切除分为二次切除组与非二次切除组,比较两组患者肿瘤残留率、无复发生存率及肿瘤进展率。结果二次切除组早期肿瘤残留率为5.6%,非二次切除组早期肿瘤残留率为8.0%,差异无统计学意义(P=0.750);中位随访42个月,二次切除组患者肿瘤进展率为5.6%,非二次切除组患者肿瘤进展率为4.0%,差异无统计学意义(P=0.810)。二次切除组3年无复发生存率为77.4%,非二次切除组3年无复发生存率为72.0%,差异无统计学意义(P=0.692)。结论对于经尿道整块切除的高危非肌层浸润性膀胱癌患者,术后6周内行二次切除似乎不能提高肿瘤残留的发现率、3年无复发生存率及无进展生存率。因此,笔者预测未来高危非肌层浸润性膀胱癌的治疗方案可能由二次切除向整块切除转变。但这些结论还需要大样本多中心随机对照临床试验来验证。Objective To compare the prognosis of patients with high-risk non-muscle invasive bladder cancer who undergo en bloc transurethral resection with or without re-resection within 6 weeks.Methods We retrospectively analyzed the clinical data of 43 patients with high-risk non-muscle invasive bladder cancer who underwent en bloc transurethral resection at the Second Affiliated Hospital of Hainan Medical University from January 2015 to October 2017,of whom age ranged from 45 to 78 years,with a mean age of 66.8 years.There were 32 men and 11 women,of whom 18 patients were with single tumours and 25 patients with multiple tumours,12 patients with stage T_(a) tumours and 31 patients with stage T_(1) tumours,8 patients with low grade tumours and 35 patients with high grade tumours.The patients were divided into re-resection group and non-re-resection group according to the presence or absence of re-resection within 6 weeks after the initial operation,and the tumor residual rate,recurrence-free survival rate and tumor progression rate were compared between the two groups.Results The early tumor residual rate was 5.6%in the re-resection group and 8.0%in the non-re-resection group,with no statistically significant difference(P=0.750).At a median follow-up of 42 months,the tumor progression rate was 5.6%for patients in the re-resection group and 4.0%for patients in the non-re-resection group,the differences were not statistically significant(P=0.810).The 3-year recurrence-free survival rate was 77.4%in the re-resection group and 72.0%in the non-re-resection group,which was not statistically significant(P=0.692).Conclusion For high-risk non-muscle invasive bladder cancer patients who underwent en bloc transurethral resection,secondary resection within 6 weeks after initial resection failed to improve early detection of residual tumor,3-year recurrence-free survival,and progression-free survival.Therefore,we predicted that future management for high-risk non-muscle invasive bladder cancer would likely evolve from re-resection to

关 键 词：高危非肌层浸润性膀胱癌 经尿道膀胱肿瘤整块切除 二次切除 肿瘤残留 预后 

分 类 号：R699.5[医药卫生—泌尿科学] R737.14[医药卫生—外科学]