钬激光整块切除术与经尿道切除术相比，可降低肿瘤直径≥3cm 的非肌层浸润性膀胱癌（NMIBC）患者的复发率：一项非随机对照研究。
Thulium laser en bloc resection reduces recurrence rates in NMIBC patients with tumor diameters ≥3cm compared to transurethral resection: a non-randomized controlled study.
机构信息
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
出版信息
BMC Cancer. 2024 Oct 8;24(1):1239. doi: 10.1186/s12885-024-13022-x.
PURPOSE
The advantages of en bloc resection of bladder tumors (ERBT) over transurethral resection of bladder tumors (TURBT) in terms of patient prognosis are not yet clear, and there are some technical limitations. We aimed to compare the tumor recurrence in non-muscle invasive bladder cancer (NMIBC) patients with tumor diameter ≥ 3 cm undergoing either TURBT or thulium laser ERBT.
METHODS
The patients included were those diagnosed with NMIBC based on pathological confirmation and underwent TURBT or modified thulium laser ERBT in the Department of Urology at Tongji Hospital from 2019 to 2024. The patients' medical records were meticulously collected and postoperative follow-up was diligently conducted by trained personnel. Recurrence-free survival curves were generated utilizing the Kaplan-Meier method, and group comparisons were performed using the log-rank trend test. To minimize biases, we employed stratified survival analysis, alongside univariate and multivariate Cox regression analysis.
RESULTS
This study included a total of 396 patients with NMIBC, with 214 undergoing TURBT and 182 undergoing ERBT. For all patients, there was no significant difference (P = 0.180) in RFS between the TURBT and ERBT groups. For patients with tumor diameter ≥ 3 cm, stratified analysis revealed that the RFS of the ERBT group was significantly better than that of the TURBT group (P = 0.033). However, in patients with tumor diameter < 3 cm, there was no significant difference (P = 0.150) between the two groups. Univariate (HR: 0.52, 95% CI 0.28-0.96, P = 0.036) and multivariate (HR: 0.49, 95% CI 0.25-0.93, P = 0.031) Cox analyses revealed that ERBT was an independent protective factor for recurrence in NMIBC patients with tumor diameter ≥3cm.
CONCLUSION
This study found that thulium laser ERBT may offer advantages in managing NMIBC patients with tumor diameters ≥ 3 cm. This could potentially drive the clinical application of thulium laser ERBT.
TRIAL REGISTRATION
Protocol was registered at Chinese Clinical Trial Register (ChiCTR) with number ChiCTR2000035407 on 12 August 2020.
目的
整块切除膀胱肿瘤（ERBT）相较于经尿道膀胱肿瘤切除术（TURBT）在患者预后方面的优势尚不清楚，且存在一些技术局限性。我们旨在比较肿瘤直径≥3cm的非肌层浸润性膀胱癌（NMIBC）患者接受 TURBT 或钬激光整块切除术的肿瘤复发情况。
方法
纳入的患者均基于病理证实诊断为 NMIBC，并于 2019 年至 2024 年在同济大学附属同济医院泌尿科接受 TURBT 或改良钬激光 ERBT。详细收集患者的病历资料，并由经过培训的人员进行术后随访。采用 Kaplan-Meier 法生成无复发生存曲线，并采用对数秩趋势检验进行组间比较。为了尽量减少偏倚，我们采用分层生存分析以及单因素和多因素 Cox 回归分析。
结果
本研究共纳入 396 例 NMIBC 患者，其中 214 例行 TURBT，182 例行 ERBT。对于所有患者，TURBT 组和 ERBT 组的 RFS 无显著差异（P=0.180）。对于肿瘤直径≥3cm 的患者，分层分析显示 ERBT 组的 RFS 明显优于 TURBT 组（P=0.033）。然而，对于肿瘤直径<3cm 的患者，两组间无显著差异（P=0.150）。单因素（HR：0.52，95%CI 0.28-0.96，P=0.036）和多因素（HR：0.49，95%CI 0.25-0.93，P=0.031）Cox 分析显示，ERBT 是肿瘤直径≥3cm 的 NMIBC 患者复发的独立保护因素。
结论
本研究发现钬激光 ERBT 可能在管理肿瘤直径≥3cm 的 NMIBC 患者方面具有优势。这可能会推动钬激光 ERBT 的临床应用。
试验注册
该研究方案于 2020 年 8 月 12 日在中国临床试验注册中心（ChiCTR）注册，注册号为 ChiCTR2000035407。
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