二次经尿道电切术对高级别 Ta 膀胱癌患者复发的影响。

Impact of second transurethral resection on recurrence in patients with high-grade Ta bladder cancer.

机构信息

Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan.

出版信息

Int J Urol. 2020 Dec;27(12):1130-1135. doi: 10.1111/iju.14372. Epub 2020 Sep 28.

DOI:10.1111/iju.14372

PMID:32985754

Abstract

OBJECTIVES

To clarify the potential therapeutic benefit of a second transurethral resection for high-grade Ta bladder cancer.

METHODS

From January 2009 to August 2019, 521 patients with bladder tumors underwent initial transurethral resection procedures at Kagawa University Hospital. Patients diagnosed with high-grade Ta bladder cancer considered to have been resected completely were included in this study. Recurrence and progression rates were compared between patients who received a second transurethral resection and those who did not.

RESULTS

We identified 97 eligible patients, including 22 patients who received a second transurethral resection. In terms of clinical characteristics, the proportion of patients with bladder cancer and upper urinary tract tumor history was lower in the second transurethral resection group than in the no second transurethral resection group (P < 0.01 and P = 0.03, respectively). The histopathological findings of 22 transurethral resection procedures were no cancer in 13 (59.2%), Ta in six (27.2%) and carcinoma in situ in three patients (13.6%). After the second transurethral resection, one patient (4.6%) had recurrent high-grade T1 bladder cancer. The no second transurethral resection group showed a 44% recurrence rate (33 patients), including five patients (6.7%) with progression, and consequently, had a higher rate of recurrence than in the second transurethral resection group (P < 0.01). Multivariate analysis showed that no second transurethral resection was the independent predictive factor influencing recurrence (hazard ratio 8.662, P = 0.04). The Kaplan-Meier curve showed that a second transurethral resection significantly decreased the recurrence rate than that of patients without a second transurethral resection (P < 0.01).

CONCLUSIONS

A second transurethral resection can reduce the recurrence rate in high-grade Ta bladder cancer, showing a possible therapeutic benefit of this procedure.

摘要

目的

阐明二次经尿道切除术治疗高级别 Ta 膀胱癌的潜在治疗益处。

方法

从 2009 年 1 月至 2019 年 8 月，在香川县立医科大学医院，521 例膀胱肿瘤患者接受了初始经尿道切除术。本研究纳入了诊断为高级别 Ta 膀胱癌且认为已完全切除的患者。比较了接受二次经尿道切除术和未接受二次经尿道切除术患者的复发率和进展率。

结果

我们确定了 97 例符合条件的患者，其中 22 例患者接受了二次经尿道切除术。在临床特征方面，与未接受二次经尿道切除术组相比，二次经尿道切除术组中膀胱癌和上尿路肿瘤病史的患者比例较低（P<0.01 和 P=0.03）。22 例经尿道切除术的组织病理学发现，无癌症 13 例（59.2%），Ta 6 例（27.2%），原位癌 3 例（13.6%）。在第二次经尿道切除术后，1 例（4.6%）患者出现复发性高级别 T1 膀胱癌。未行二次经尿道切除术组的复发率为 44%（33 例），其中 5 例（6.7%）患者进展，因此，复发率高于行二次经尿道切除术组（P<0.01）。多因素分析显示，未行二次经尿道切除术是影响复发的独立预测因素（危险比 8.662，P=0.04）。Kaplan-Meier 曲线显示，二次经尿道切除术显著降低了复发率，优于未行二次经尿道切除术组（P<0.01）。