高危非肌层浸润性膀胱癌首次电切术后肿瘤残余及二次电切术后复发相关危险因素分析  

Analysis of risk factors associated with tumor residue after first resection and recurrence after repeat transurethral resection for high risk non-muscle-invasive bladder cancer

作　　者：豆鹏 钟鑫 陈荣[1] 谭平[1] 张朋[1] DOU Peng;ZHONG Xin;CHEN Rong;TAN Ping;ZHANG Peng(Department of Urology,West China Hospital,Sichuan University,Chengdu,610041,China)

机构地区：[1]四川大学华西医院泌尿外科,成都610041

出　　处：《临床泌尿外科杂志》2023年第12期898-904,909,共8页Journal of Clinical Urology

基　　金：四川省重点研发项目(No:2023YFS0315)。

摘　　要：目的:探讨高危非肌层浸润性膀胱癌(non-muscle-invasive bladder cancer,NMIBC)患者首次电切术后肿瘤残余的危险因素以及二次电切(repeat transurethral resection,re-TUR)术后患者的复发情况及相关危险因素,旨在为临床开展re-TUR提供更多依据。方法:回顾性分析四川大学华西医院2020年1月—2023年8月收治的行经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)后并于2~6周内行re-TUR的高危NMIBC患者的临床及病理资料。统计本中心首次电切术后肿瘤残余的发生率;利用logistic回归模型分析可能影响首次电切术后肿瘤残余的因素;利用Cox回归模型分析可能影响re-TUR术后肿瘤复发的危险因素。结果:本研究共纳入171例患者,re-TUR术后发现肿瘤残余65例(38.01%),中位随访时间24.03(0.9,49.2)个月。随访期间,42例(24.56%)患者复发,其中1年复发率为15.20%,2年复发率为23.98%,其中9例(5.26%)复发患者出现疾病进展。单因素logistic回归分析结果显示,肿瘤残余与肿瘤高级别(P=0.012)、合并卫星灶(P=0.022)显著相关。多因素logistic回归分析显示:合并卫星灶(P=0.024)是肿瘤残余的独立相关危险因素。单因素Cox回归分析结果显示,术后膀胱灌注卡介苗(BCG)(P=0.012)、肿瘤残余(P=0.006)、高白蛋白与碱性磷酸酶比值(albumin to alkaline phosphatase ratio,AAPR)(P=0.010)、高白蛋白与纤维蛋白原比值(albumin to fibrinogen ratio,AFR)(P=0.018)与无复发生存期(recurrence-free survival,RFS)显著相关。多因素Cox回归分析结果显示,肿瘤残余(P=0.002)是肿瘤复发的独立相关危险因素,术后膀胱灌注BCG(P=0.001)和高AFR(P=0.017)是影响肿瘤复发的保护因素。结论:在高危NMIBC患者中,肿瘤残余与肿瘤高级别、合并卫星灶显著相关,合并卫星灶是影响首次电切后肿瘤残余的独立相关危险因素,推荐具有肿瘤残余高危因素(合并卫星灶)的患者接受re-TUR。术后膀胱灌注BCG、肿Objective To investigate risk factors of residual tumor after first resection and recurrence after repeat transurethral resection in high-risk non-muscle-invasive bladder cancer(NMIBC)patients,and related risk factors were reported to provide more evidence for clinical repeat transurethral resection(re-TUR).Methods We retrospectively analysed the clinicopathological data of high-risk NMIBC patients admitted to our center from January 2020 to August 2023 who underwent transurethral resection of bladder tumor(TURBT)and underwent re-TUR within 2 to 6 weeks.The incidence of tumor residual after the first resection was analyzed.Logistic regression model was used to analyze the factors that might affect the tumor residual after the first resection.Cox regression model was used to analyze the risk factors that may affect tumor recurrence after re-TUR.Results A total of 171 patients were included in this study.After re-TUR,tumor residual was found in 65 cases(38.01%).The median follow-up time was 24.03(0.9,49.2)months.During the follow-up period,42 patients(24.56%)relapsed,of which the 1-year recurrence rate was 15.20%,and the 2-year recurrence rate was 23.98%,and 9 patients(5.26%)had disease progression.Univariate logistic regression analysis showed that tumor residual was significantly correlated with tumor grade(P=0.012)and satellite focus(P=0.022).Multivariate logistic regression analysis showed that combined satellite focus(P=0.024)was an independent risk factor for tumor residual.Univariate Cox regression analysis showed that postoperative bladder perfusion BCG(P=0.012),tumor residual(P=0.006),high albumin to alkaline phosphatase ratio(AAPR)(P=0.010)and high albumin to fibrinogen ratio(AFR)(P=0.018)were significantly associated with recurrence-free survival(RFS).Multivariate Cox regression analysis showed that tumor residual(P=0.002)was an independent risk factor for tumor recurrence,and postoperative bladder perfusion with BCG(P=0.001)and high AFR(P=0.017)were protective factors for tumor recurrence.Conclusion In

关 键 词：非肌层浸润性膀胱癌 二次电切 肿瘤残余 肿瘤复发 危险因素 

分 类 号：R737.14[医药卫生—肿瘤]