肌层浸润性膀胱癌保留膀胱术后复发与进展的相关因素分析

目的 探讨影响肌层浸润性膀胱癌保留膀胱术后复发与进展的相关因素,为临床选择肌层浸润性膀胱癌患者行保留膀胱手术提供依据.方法 回顾性分析获得系统随访的38例行保留膀胱手术的肌层浸润性膀胱癌患者的资料,对性别、年龄、肿瘤数目、肿瘤大小、病理分级、既往复发、手术方式、即刻灌注、静脉化疗等因素进行生存分析,定义复发或进展为终点事件.生存分析运用Kaplan-Meier法,单因素与多因素分析运用Cox回归,采用Log-rank法进行显著性检验.结果 随访3~36个月,25例复发(复发率65.8%),17例进展(进展率44.7%).复发时间(11.6±0.8)个月,中位复发时间11个月,未复发生存时间(19.9±1.5)个月,中位生存时间19个月.进展时间(11.2±1.2)个月,中位进展时间10个月.Cox单因素分析发现,肿瘤数目、肿瘤大小、病理分级、既往复发、静脉化疗均是影响肿瘤复发与进展的因素;Cox多因素分析发现,肿瘤数目(RR=2.968,P=0.004)、病理分级(RR=2.128,P=0.027)是影响肿瘤复发的独立危险因素,肿瘤数目(RR=4.519,P=0.003)、病理分级(RR=3.137,P=0.014)同样是影响肿瘤进展的独立危险因素. 结论 肿瘤数目、病理分级是影响肌层浸润性膀胱癌保留膀胱术后复发与进展的独立危险因素,临床上尽可能选择肿瘤数目较少、病理分级较低的肌层浸润性膀胱癌患者行保留膀胱手术.

Analyze the factors that influence recurrence and progression after bladder-preserving operation for muscle-invasive bladder cancer

Objective To analyze the factors related to the recurrence and progression of muscle-invasive bladder cancer after bladder-preserving operation.Methods Clinical data of 38 cases with muscle-invasive bladder cancer undergoing bladder-preserving operation were retrospectively analyzed.Sex, age, tumor number, tumor size, grade, previous recurrence, surgical approach, immediate intravesical chemotherapy, intravenous chemotherapy were supposed to be the risk factors.Survival analysis, including univariate analysis and multivariate analysis, was carried out by employing Kaplan-Meier and Cox proportional hazard model.Results Based on 3-36 months of following up, 25 (65.8%) of 38 cases had recurrence and 17 (44.7%) cases had progression.The relapse time was (11.6±0.8) months, the median relapse time was 11 months, the relapse-free survival time was (19.9±1.5) months, the median survival time was 19 months.The time to progression was (11.2±1.2) months and the median time to progression was 10 months.Cox univariate analysis found that tumor number, tumor size, grade, previous recurrence, intravenous chemotherapy were the factors that affected recurrence and progression.Cox multivariate analysis found that tumor number and grade were independent risk factors.Conclusions The tumor number and grade were independent risk factors affected recurrence and progression after bladder-preserving operation for muscle-invasive bladder cancer.