白光膀胱镜下初次经尿道膀胱肿瘤切除术治疗非肌层浸润性膀胱癌患者中正常黏膜原位癌的术前预测因素。
Preoperative predictive factors of carcinoma in situ in the normal-appearing mucosa in patients who underwent an initial transurethral resection for non-muscle-invasive bladder cancer under white light cystoscopy.
机构信息
Department of Urology, Gifu University Graduate, School of Medicine, Gifu, Japan.
Department of Urology, Japanese Red Cross Takayama Hospital, Takayama, Japan.
出版信息
Cancer Rep (Hoboken). 2021 Apr;4(2):e1321. doi: 10.1002/cnr2.1321. Epub 2020 Nov 11.
BACKGROUND
Although few studies evaluated the significance of random biopsies under white light cystoscopy (WLC) in patients with non-muscle-invasive bladder cancer (NMIBC), the findings are controversial.
AIM
This aim of this study was to evaluate what kind of preoperative covariates were useful as predictive factors in detecting carcinoma in situ (CIS) from normal-appearing mucosa using random bladder biopsies under WLC.
METHODS AND RESULTS
A total of 229 patients with NMIBC underwent initial TUR followed by random biopsies under WLC at Red Cross Takayama Hospital between 2007 and 2016. These patients underwent TUR with complete resection of intravesical visible tumors followed by random biopsies of normal-appearing mucosa. In this study, random bladder biopsies of normal-appearing urothelial mucosa, excluding abnormal mucosa, were carried out with a cold punch in the selected intravesical sites. The covariates included age, gender, the urine cytology result, presence of an abnormal mucosa, number of tumors, size of the largest tumors, configuration of the tumor, and tumor type. Abnormal mucosa was defined as reddish or mossy areas at the time of TUR under WLC. The primary endpoint was to determine what kind of preoperative covariates were useful as predictive factors in detecting CIS from normal-appearing mucosa using random bladder biopsies under WLC. Finally, 212 patients were evaluated, and 67 patients (31.6%) were diagnosed with CIS from normal-appearing mucosa. In univariate analysis, positive urine cytology, abnormal mucosa, and the number of tumors were significantly associated with concomitant CIS. On multivariate analysis, positive urine cytology and abnormal mucosa were significantly associated with CIS.
CONCLUSION
The patients who were diagnosed with positive urine cytology or abnormal mucosa by WLC are ideal candidates for TUR followed by random biopsy of normal-appearing mucosa.
背景
虽然很少有研究评估在非肌肉浸润性膀胱癌（NMIBC）患者中在白光膀胱镜检查（WLC）下进行随机活检的意义，但结果存在争议。
目的
本研究旨在评估在 WLC 下使用随机膀胱活检从外观正常的黏膜中检测原位癌（CIS）时，哪些术前协变量可用作预测因子。
方法和结果
2007 年至 2016 年期间，共有 229 例 NMIBC 患者在红十字高田医院接受了初始 TUR 加 WLC 下的随机活检。这些患者接受了 TUR，完全切除了膀胱内可见的肿瘤，然后对外观正常的黏膜进行了随机活检。在这项研究中，在选定的膀胱内部位，使用冷冲孔对外观正常的尿路上皮黏膜（不包括异常黏膜）进行随机膀胱活检。协变量包括年龄、性别、尿细胞学结果、异常黏膜存在、肿瘤数量、最大肿瘤大小、肿瘤形态和肿瘤类型。异常黏膜定义为在 WLC 下 TUR 时出现的红色或苔藓状区域。主要终点是确定在 WLC 下使用随机膀胱活检从外观正常的黏膜中检测 CIS 时，哪些术前协变量可用作预测因子。最终，212 例患者接受了评估，其中 67 例（31.6%）患者被诊断为来自外观正常黏膜的 CIS。在单因素分析中，阳性尿细胞学、异常黏膜和肿瘤数量与同时存在的 CIS 显著相关。在多因素分析中，阳性尿细胞学和异常黏膜与 CIS 显著相关。
结论
通过 WLC 诊断为阳性尿细胞学或异常黏膜的患者是 TUR 加随机活检外观正常黏膜的理想候选者。
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