Chen Xu, Liao Jun, Chen Lingwu, Qiu Shaopeng, Mo Chengqiang, Mao Xiaopeng, Yang Yuanzhong, Zhou Shiying, Chen Junxing
Department of Urology, Sun Yat-Sen University, Guangzhou, China.
World J Urol. 2015 Jul;33(7):989-95. doi: 10.1007/s00345-014-1342-1. Epub 2014 Jun 21.
To evaluate the practicability of en bloc transurethral resection with 2-micron continuous-wave laser as treatment for primary non-muscle-invasive bladder cancer (NMIBC).
This was a single-center, randomized, controlled trial involving 142 patients with newly diagnosed NMIBC. All patients were randomly assigned in a 1:1 ratio to receive either laser treatment or conventional transurethral resection of bladder tumor (TURBT). All patients received intravesical chemotherapy. Follow-up was performed in 18 months. Primary outcome measure was difference of tumor recurrence rate at the end of study.
Baseline characteristics did not differ between patients in two groups. Operation time was longer in laser group than in TURBT group (56.5 ± 37.4 vs. 41.0 ± 29.4 min, P = 0.017). Obturator nerve reflection was noted during TURBT in 18 patients, whereas none was noted during laser resection. Number of T1 tumors was higher in the laser group (25 vs. 15, P = 0.047). According to Kaplan-Meier survival curves, there was no statistical difference in the rate of recurrence in 18 months (P = 0.383). All recurrences were out of the site of first resection, and there was no progression in tumor grade.
Two-micron continuous-wave laser did not diminish tumor recurrence rate in primary NMIBC for 18-months observation. However, T1 tumors were significantly higher among laser group. Clear and complete tumor bases were easily conserved by laser resection, which may enable pathologists to distinguish the T stages of bladder cancer more easily. Further studies need to be done in future.
评估2微米连续波激光整块经尿道切除术治疗原发性非肌层浸润性膀胱癌（NMIBC）的实用性。
这是一项单中心、随机、对照试验，纳入142例新诊断的NMIBC患者。所有患者按1:1比例随机分配接受激光治疗或传统经尿道膀胱肿瘤切除术（TURBT）。所有患者均接受膀胱内化疗。随访18个月。主要观察指标为研究结束时肿瘤复发率的差异。
两组患者的基线特征无差异。激光组的手术时间比TURBT组长（56.5±37.4对41.0±29.4分钟，P = 0.017）。TURBT期间有18例患者出现闭孔神经反射，而激光切除期间未观察到。激光组T1期肿瘤数量较多（25对15，P = 0.047）。根据Kaplan-Meier生存曲线，18个月时复发率无统计学差异（P = 0.383）。所有复发均发生在首次切除部位以外，且肿瘤分级无进展。
在18个月的观察期内，2微米连续波激光并未降低原发性NMIBC的肿瘤复发率。然而，激光组中T1期肿瘤明显更多。激光切除易于保留清晰完整的肿瘤基底部，这可能使病理学家更容易区分膀胱癌的T分期。未来需要进一步研究。
