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中国人群经尿道膀胱肿瘤电切术(TURBt)后非肌层浸润性膀胱癌(NMIBC)复发危险因素的评估

The evaluation of the risk factors for non-muscle invasive bladder cancer (NMIBC) recurrence after transurethral resection (TURBt) in Chinese population.

作者信息

Liu Shenghua, Hou Junyao, Zhang Hu, Wu Yishuo, Hu Mengbo, Zhang Limin, Xu Jianfeng, Na Rong, Jiang Haowen, Ding Qiang

机构信息

Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China; Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.

Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China; Department of Urology, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Science, Fudan University, Shanghai, China; Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.

出版信息

PLoS One. 2015 Apr 7;10(4):e0123617. doi: 10.1371/journal.pone.0123617. eCollection 2015.

Abstract

OBJECTIVE

The risk factors of bladder cancer recurrence after transurethral resection of bladder tumor (TURBt) were poorly understood, especially in Chinese population. This study evaluated the potential risk factors of recurrence based on a Chinese population.

MATERIALS AND METHODS

A total of 698 patients that received TURBt procedure in our institute from 2000 to 2012 were recruited in this study. Clinical information was collected. The patients were followed up according to the schedule recommended by Chinese guideline.

RESULTS

A total of 583 males (83.5%) and 115 females (16.5%) were enrolled in our study. The median follow-up duration was 51.5 months. Gender, chief complain, tumor size, number of lesions, histological grade and chemotherapeutic agents were found significantly associated with patients' short-term recurrence (less than 1 year) (All p<0.05). In the multivariate analysis, tumor size, number of lesions, histological grade and chemotherapeutic agents were significantly related to patients' short-term recurrence (less than 1 year) (All p<0.05). A multivariate model based on tumor size, number of lesions, histological grade and chemotherapeutic agents had an AUC of 0.697, which significantly improved the prediction utility for bladder cancer short-term recurrence (less than 1 year) than any single factor In the multivariate Cox regression, tumor size greater than 3 cm, multifocal lesions, worsen histological grade and non-urothelial carcinoma was related to time to recurrence (TR).

CONCLUSION

Patients with larger tumor size, multifocal number of lesions, higher tumor grade and who received chemotherapeutic agents other than Epirubicin and Pirarubicin might have higher risks of recurrence less than 1 year. Tumor size, number of lesions, pathology and histological grade might be associated with TR. As Bacille Calmette-Guerin (BCG) is currently not approved for bladder cancer in China, Epirubicin and Pirarubicin might be considered prior to other chemotherapy medications when providing post-operative instillation of chemotherapy.

摘要

目的

经尿道膀胱肿瘤电切术(TURBt)后膀胱癌复发的危险因素尚不清楚,尤其是在中国人群中。本研究基于中国人群评估复发的潜在危险因素。

材料与方法

本研究纳入了2000年至2012年在我院接受TURBt手术的698例患者。收集临床信息。按照中国指南推荐的时间表对患者进行随访。

结果

本研究共纳入583例男性(83.5%)和115例女性(16.5%)。中位随访时间为51.5个月。发现性别、主要症状、肿瘤大小、病灶数量、组织学分级和化疗药物与患者短期复发(小于1年)显著相关(所有p<0.05)。在多因素分析中,肿瘤大小、病灶数量、组织学分级和化疗药物与患者短期复发(小于1年)显著相关(所有p<0.05)。基于肿瘤大小、病灶数量、组织学分级和化疗药物的多因素模型的曲线下面积(AUC)为0.697,与任何单一因素相比,显著提高了对膀胱癌短期复发(小于1年)的预测效用。在多因素Cox回归中,肿瘤大小大于3 cm、多灶性病变、组织学分级恶化和非尿路上皮癌与复发时间(TR)相关。

结论

肿瘤体积较大、病灶数量多、肿瘤分级高以及接受表柔比星和吡柔比星以外化疗药物的患者可能有小于1年的较高复发风险。肿瘤大小、病灶数量、病理和组织学分级可能与TR相关。由于卡介苗(BCG)目前在中国未被批准用于膀胱癌,在提供术后化疗灌注时,与其他化疗药物相比,可能优先考虑表柔比星和吡柔比星。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/229e/4388336/96b3731758e9/pone.0123617.g001.jpg

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