初发性与复发性非肌层浸润性膀胱癌卡介苗灌注治疗的疗效分析  

Efficacy Analysis of BCG Perfusion Therapy for Primary and Recurrent Non-muscle Invasive Bladder Cancer

作　　者：任学兆 郭禹封 水源 于伟涛 王志平[2] REN Xuezhao;GUO Yufeng;SHUI Yuan(The Second Hospital&Clinical Medical School,Lanzhou University,Gansu 730030,China)

机构地区：[1]兰州大学第二临床医学院,730030 [2]兰州大学第二医院泌尿外科,730030

出　　处：《医学研究杂志》2025年第3期34-39,共6页Journal of Medical Research

基　　金：国家自然科学基金资助项目(82060459)。

摘　　要：目的探讨初发性与复发性非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC)在经尿道膀胱肿瘤切除术(transurethral resection of bladder tumors,TURBT)后卡介苗(bacillus calmette-guérin,BCG)灌注治疗的疗效及危险因素。方法回顾性分析2016年5月~2021年12月兰州大学第二医院收治的TURBT术后灌注BCG的122例NMIBC患者的临床病理及随访资料,根据发病类型将患者分为初发组(n=79)和复发组(n=43),比较两组患者的临床病理特征,包括性别、年龄、肿瘤数目、病理分期、病理分级及术前炎性指数[全身免疫炎性指数(systemic immune inflammation index,SII)、中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)、单核细胞与淋巴细胞比值(monocyte-to-lymphocyte ratio,MLR)]。采用单因素COX回归分析评估肿瘤复发的相关危险因素,并采用Kaplan-Meier法进行生存差异分析。结果单因素COX回归分析结果显示,病理分期和分级是影响复发组患者BCG灌注治疗失败的危险因素(P<0.05)。Kaplan-Meier生存分析结果显示,复发组中T_(1)期、高级别和高级别T_(1)期肿瘤的复发风险显著高于初发组(P<0.05),复发组组内高级别T_(1)期肿瘤复发的风险显著高于其他肿瘤(P<0.05)。结论病理分期和分级是复发性NMIBC患者采用BCG灌注治疗失败的危险因素。复发性高级别T_(1)期NMIBC患者使用BCG灌注治疗的复发率显著高于非复发性高级别T_(1)期肿瘤。因此,对于复发性高级别T_(1)期NMIBC患者的治疗应该慎重选择BCG灌注治疗,必要时可选择根治性膀胱切除术。Objective To investigate the efficacy and risk factors of Bacillus Calmette-Guérin(BCG)perfusion therapy after transurethral resection of bladder tumors(TURBT)in primary and recurrent non-muscle invasive bladder cancer(NMIBC).Methods The clinicopathological and follow-up data of 122 patients with NMIBC infused with BCG vaccine after TURBT in the Second Hospital of Lanzhou University from May 2016 to December 2021 were retrospectively analyzed,and the patients were divided into the primary group(n=79)and recurrent group(n=43)according to the type of onset of the disease,and the clinicopathological characteristics of the two groups were compared,including gender,age,number of tumors,pathological stage,pathological grade,and preoperative inflammation index[systemic immune inflammation index(SII),neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),monocyte-to-lymphocyte ratio(MLR)].Univariate COX regression analysis was used to evaluate the risk factors associated with tumor recurrence,and Kaplan-Meier was used for survival difference analysis.Results The results of Univariate COX regression analysis showed that pathological stage and grade were risk factors affecting the failure of BCG perfusion therapy in patients with recurrent bladder cancer(P<0.05).The results of Kaplan-Meier survival analysis showed that the risk of recurrence of stage T_(1),high-grade and high-grade T_(1)tumors in the recurrence group was significantly higher than that in the primary group(P<0.05),and the risk of recurrence of high-grade T_(1)tumors in the recurrence group was significantly higher than that of other tumors(P<0.05).Conclusion Pathological stage and grade are risk factors for failure of BCG perfusion therapy for recurrent NMIBC.The recurrence rate of BCG perfusion therapy for recurrent high-grade T_(1)NMIBC is significantly higher than non-recurrent high-grade T_(1)stage tumors.Therefore,BCG perfusion therapy should be chosen carefully for the treatment of recurrent high-grade T_(1)stage NMIBC,with the option

关 键 词：非肌层浸润性膀胱癌 卡介苗 疗效分析 危险因素 

分 类 号：R694[医药卫生—泌尿科学]