首诊T1期膀胱尿路上皮癌患者二次经尿道膀胱肿瘤电切除术的临床意义

目的 探讨经尿道膀胱肿瘤二次电切除术(二次电切)对首诊为T1期膀胱尿路上皮癌患者的临床意义.方法 收集资料完整的膀胱尿路上皮癌患者142例,首次经尿道膀胱肿瘤电切术后病理诊断均为T1期膀胱尿路上皮癌,其中68例患者进行了二次电切,观察肿瘤残留率以及分期变化,并与未接受二次电切患者的肿瘤复发率、无复发生存时间、无复发生存率以及肿瘤进展率等情况进行比较.结果 两组患者性别、年龄、随访时间、肿瘤数量、肿瘤大小、肿瘤分级等,差异均无统计学意义(均为P＞0.05).68例行二次电切的患者中,术后病理证实有肿瘤残余25例(36.8%),其中发现肿瘤浸润至肌层6例(8.8%).术后平均随访时间26.8个月,接受二次电切的患者中,肿瘤复发23例(37.1%),中位无复发生存时间21个月,无复发生存率41.0%,肿瘤进展9例(14.5%);未行二次电切的患者中分别为43例(58.1%)、12个月、35.1%、19例(25.7%);两组间肿瘤复发率(x2=5.962,P=0.015)、无复发生存时间(U=1584,P=0.002)、无复发生存率(x2=8.502,P=0.004)比较,差异均有统计学意义;肿瘤进展率差异无统计学意义(x2=2.570,P=0.109).结论 二次电切是彻底切除肿瘤的有效方法,对改善T1期膀胱尿路上皮癌复发率、无复发生存时间及无复发生存率有良好的效果,但对肿瘤进展率的影响尚需进一步研究.

Clinical significance of second transurethral resection in newly diagnosed patients with T1 urothelial cell carcinoma of the bladder

Objective To explore the clinical significance of second transurethral resection (TUR) in patients with T1 urothelial cell carcinoma of the bladder.Methods The 142 cases with urothelial carcinoma were recruited.All patients underwent transurethral resection of bladder tumor (TURBT) and were diagnosed as stage T1 urothelial carcinoma of the bladder.The 68 of 142 cases underwent second TUR after the initial surgery.Tumor recurrence rate,progression rate and recurrence-free survival were compared.Results There were no statistical differences in age,gender,follow-up time,number of tumors,size of tumors or grade of tumors between patients with and without second TUR.Of the 68 cases that underwent second TUR,25 cases (36.8%) had residual tumor and 6 of them (8.8%) had muscle-invasive bladder cancer.After an average observation for 26.8 months,patients who underwent second TUR showed lower recurrence rate,higher recurrence-free rate and longer recurrence-free survival than patients without second TUR [37.1% vs.58.1%,x2=5.962,P=0.015;41% vs.35.1%,x2=8.502,P=0.004;21 months vs.12 months,U= 1584,P= 0.002].While the progression rate showed no statistical difference between them (14.5% vs.25.7%,x2 =2.570,P=0.109).Conclusions Second TUR provides an effective way to completely excise tumor.Second TUR is beneficial to the decrease of recurrence rate and improvement of recurrence-free survival.However,its effect on tumor progression needs further discussion.