膀胱肿瘤en-bloc手术标本T1亚期及水平/垂直切缘的判定与患者临床预后的相关性研究  

Study on the correlation between pT1 sub-stage, horizontal, vertical margin of en-bloc resection and clinical prognosis of patients with non-muscle-invasive bladder cancer

作　　者：胡嘏 陈耀兵 胡恒龙 李凡[1] 刘征 宋晓东[1] 王少刚[1] HU Jia;CHEN Yaobing;HU Henglong;LI Fan;LIU Zheng;SONG Xiaodong;WANG Shaogang(Department of Urology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030,China;Department of Pathology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology)

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030 [2]华中科技大学同济医学院附属同济医院病理科

出　　处：《临床泌尿外科杂志》2023年第12期905-909,共5页Journal of Clinical Urology

摘　　要：目的:评估经尿道膀胱肿瘤整块(en-bloc)切除治疗非肌层浸润性膀胱癌(non-muscular-invasive bladder cancer, NMIBC)的手术标本T_(1)亚期及水平/垂直切缘的判定与患者临床预后的相关性。方法:收集2017年1月—2018年5月华中科技大学同济医学院附属同济医院收治的经尿道膀胱肿瘤整块切除、规范送检的158例NMIBC患者手术标本,病理规范读片明确每个标本的水平切缘及垂直切缘是否阳性、pT_(1)亚期等。评估主要指标为外科切缘及pT_(1)亚期与患者疾病无复发生存(recurrence free survival, RFS)的相关性,次要指标为手术安全性等。结果:肿瘤的平均直径为(20.5±7.8) mm。158例患者中,病理医师能准确判定出水平切缘93例,垂直切缘152例,其中水平切缘局灶阳性的患者18例(19.4%),垂直切缘阳性的患者13例(8.6%)。对上述切缘阳性患者均进行二次电切,水平切缘阳性患者中可见3例pTa期肿瘤残留,未见pT_(1)期肿瘤;垂直切缘阳性患者中可见4例pTa/pT_(1)期肿瘤残留,2例pT_(2)期肿瘤(该2例患者二次电切病理分期升高,予以剔除)。可统计的156例患者中,94例患者的病理分期为pTa期,62例患者为pT_(1)期;病理分级低级别患者57例,高级别患者99例。62例pT_(1)期肿瘤准确判读亚期患者41例(66.1%),其中pT_(1)a期24例(58.5%),pT_(1)b期17例(41.5%)。平均随访38.4个月,pT_(1)a腔内复发率为29.1%(7/24),pT_(1)b腔内复发率为88.2%(15/17)。生存分析显示pT_(1)b期与患者较短的RFS显著相关。结论:整块切除能提供更优的病理标本获取临床预后的信息。外科切缘阳性,特别是垂直切缘阳性的患者建议施行二次电切。pT_(1)b期的患者存在较短的RFS,临床需严密随访,及早干预。Objective To evaluate the clinical importance of T_(1) sub-stage,horizontal and vertical margin in patients with non-muscle-invasive bladder cancer(NMIBC)who underwent transurethral en-bloc resection of bladder tumour(ERBT)with Hybrid Knife.Methods This was an observational retrospective,single centre study.From January 2017 to May 2018,We retrospectively analyzed the records of 158 consecutive patients who underwent ERBT for treatment of NMIBC.All specimens were analyzed for horizontal,vertical margin and pT_(1) sub-staging.Primary endpoints were prognostic values of pT_(1) sub-staging and surgical margin.The secondary endpoint was the perioperative and oncological outcome.Results Mean tumor diameter was(20.5±7.8)mm.Pathological stages were 94 cases in pTa and 62 cases in pT_(1),2 cases with pT_(2) were excluded.The horizontal and vertical margins that pathologists could accurately recognized were 93 cases and 152 cases,respectively.There were 18 patients(19.4%)with horizontal margins positive and 13 patients(8.6%)with vertical margins positive.A second TUR was performed in 31 of the patients with horizontal and vertical margins positive,and 9 cases were confirmed tumor residue.Among the 62 patients with pT_(1) stage tumors,24 cases were(58.5%)pT_(1)a stage and 17(41.5%)were pT_(1)b stage.Mean follow-up period was 43 months(ranged from 37 to 50 months).Recurrence rate were 29.1%(7;24)in patients with pT_(1)a vs.88.2%(15;17)in patients with pT_(1)b.In multivariate analysis,pT_(1)b stage was an independent prognostic factor for recurrence.Conclusion ERBT with Hybrid Knife for treatment of NMIBC is safe and effective,and high-quality specimens can be obtained.Patients with positive surgical margins,especially those with positive vertical margins,are recommended to undergo a second TUR.Patients with pT_(1)b stage have a relatively short RFS,so they requires early intervention in clinical practice.

关 键 词：非肌层浸润性膀胱癌 整块切除 外科切缘 pT1亚期 无复发生存 

分 类 号：R737.14[医药卫生—肿瘤]