Li Xiao-dong, Sun Guang, Liu Xiao-qiang
Department of Urology, the Second Affiliated Hospital of Tianjin Medical University, Tianjin 300211, China.
Zhonghua Wai Ke Za Zhi. 2013 Aug;51(8):741-5.
To formulate the systems of prognostic evaluation that allowed urologists to easily calculate a T1G3 bladder cancer patient's short- and long-term risk score of recurrence, progression and death after transurethral resection.
The 187 cases with T1G3 bladder cancer were diagnosed from January 1998 to October 2006. Clinical epidemiology study was carried out and prognosis information were collected. The expression of p53, fibroblast growth factor receptor 3 (FGFR3), E-cadherin, Ki-67 and microvesseldensity (MVD) of all patients' samples were detected using immunohistochemistry. The 18 prognostic risk factors were planed to estimate including gender, age, the time from symptom emerging to visiting doctor, hydronephrosis, operation ways, immediately intravesical instillation, drug of intravesical instillation, tumor size, number of tumors, tumor modality, cancer in situ, the first recurrence time ≤ 6 months, frequency of recurrence, p53, FGFR3, E-cadherin, Ki-67 and MVD. The risk factors were preliminary screened with Kaplan-Meier univariate analysis and then determined finally with multivariate Cox proportional hazards regression model. Based on the coefficients of the variables in the multivariate model, a weight for each level of each variable was obtained and the prognostic evaluation score of T1G3 bladder cancer was calculated.
Based on an average follow-up of 46 months, 100 cases of T1G3 bladder cancer recurred (53.5%), 61 cases progressed (32.6%) and 37 cases died (19.8%). The 1-, 2-, 3-, 5-year probability of tumor recurrence was 35.0%, 60.0%, 63.0%, 65.0%. The 1-, 2-, 3-, 5-year probability of disease progression was 12.0%, 27.0%, 34.0%, 38.0% and the 1-, 2-, 3-, 5-year probability of death was 0, 11.0%, 17.0%, 26.0% respectively. The tumor size, number of tumors, immediately intravesical instillation, the first recurrence time ≤ 6 months, p53 and FGFR3 were the risk factors of the tumor recurrence of T1G3 bladder cancer. The total recurrence risk score of each patient was calculated. According the recurrence risk score, the patients were divided into -3-6 group, 7-19 group and 20-32 group. The 1-year probability of tumor recurrence was 3%, 35%, 81% in each group and the 5-year probability of tumor recurrence was 20%, 65%, 100%. The tumor modality, cancer in situ, the first recurrence time ≤ 6 months, frequency of recurrence, p53 and E-cadherin were the risk factors of the disease progression. The total progression risk score of each patient was calculated. According the progression risk score, the patients were divided into 6-14 group, 15-23 group and 24-30 group. The 1-year probability of progression was 2%, 19%, 56% in each group and the 2-year probability was 7%, 33%, 88%.Only progression was the risk factor of death (RR = 324.70, 95%CI:9.848-10707.800) .
Based on the risk coefficient was translated into prognostic score and the tables of prognostic evaluation of T1G3 bladder cancer was founded initially, which showed the influence of each risk factor with intuitional scores. The model of prognostic evaluation of T1G3 bladder cancer could help the urologist to make decisions conveniently.
制定预后评估系统，使泌尿外科医生能够轻松计算经尿道切除术后T1G3膀胱癌患者复发、进展和死亡的短期及长期风险评分。
收集1998年1月至2006年10月诊断的187例T1G3膀胱癌患者。进行临床流行病学研究并收集预后信息。采用免疫组织化学法检测所有患者样本中p53、成纤维细胞生长因子受体3（FGFR3）、E-钙黏蛋白、Ki-67和微血管密度（MVD）的表达。计划评估18个预后危险因素，包括性别、年龄、症状出现至就诊时间、肾积水、手术方式、即刻膀胱内灌注、膀胱内灌注药物、肿瘤大小、肿瘤数量、肿瘤形态、原位癌、首次复发时间≤6个月、复发频率、p53、FGFR3、E-钙黏蛋白、Ki-67和MVD。通过Kaplan-Meier单因素分析初步筛选危险因素，然后用多因素Cox比例风险回归模型最终确定。根据多因素模型中变量的系数，获得每个变量各水平的权重，计算T1G3膀胱癌的预后评估评分。
平均随访46个月，187例T1G3膀胱癌患者中100例复发（53.5%），61例进展（32.6%），37例死亡（19.8%）。肿瘤复发的1年、2年、3年、5年概率分别为35.0%、60.0%、63.0%、65.0%。疾病进展的1年、2年、3年、5年概率分别为12.0%、27.0%、34.0%、38.0%，死亡的1年、2年、3年、5年概率分别为0、11.0%、17.0%、26.0%。肿瘤大小、肿瘤数量、即刻膀胱内灌注、首次复发时间≤6个月、p53和FGFR3是T1G3膀胱癌肿瘤复发的危险因素。计算每位患者的总复发风险评分。根据复发风险评分，将患者分为-3-6分组、7-19分组和20-32分组。每组肿瘤复发的1年概率分别为3%、35%、81%，5年概率分别为20%、65%、100%。肿瘤形态、原位癌、首次复发时间≤6个月、复发频率、p53和E-钙黏蛋白是疾病进展的危险因素。计算每位患者的总进展风险评分。根据进展风险评分，将患者分为6-14分组、15-23分组和24-30分组。每组进展的1年概率分别为2%、19%、56%，2年概率分别为7%、33%、88%。仅进展是死亡的危险因素（RR = 324.70，95%CI：9.848-10707.800）。
基于风险系数转化为预后评分，初步建立了T1G3膀胱癌预后评估表，以直观的评分显示各危险因素的影响。T1G3膀胱癌预后评估模型有助于泌尿外科医生方便地做出决策。
