T1G3膀胱尿路上皮癌复发与进展影响因素分析

目的探讨影响T1G3膀胱尿路上皮癌复发与进展的因素,为临床治疗提供循证医学依据。方法回顾性分析1997年至2009年我科治疗的62例行经尿道膀胱肿瘤电切术(TURBT)+膀胱灌注治疗的T1G3膀胱尿路上皮癌患者,对这些患者进行随访并对生存预后进行分析。生存函数运用Kaplan-Meier法,单因素和多因素分析运用Cox回归,并采用Log-rank法行显著性检验。结果中位随访期40个月(6～140个月),41例(66.0%)复发,2、5年无复发生存率分别为43.4%、35.1%。14例(23.0%)出现进展,2、5年无进展生存率分别为86.4%、83.5%。将与复发相关的危险因素纳入Cox回归多因素生存分析后提示肿瘤复发的危险因素为肿瘤数目(RR=2.250)、肿瘤大小(RR=1.039)、既往复发情况(RR=2.162),P均<0.05;与进展相关的危险因素纳入Cox回归多因素生存分析,提示肿瘤进展的危险因素为肿瘤数目(RR=3.695)。结论肿瘤数目是T1G3膀胱尿路上皮癌复发最大的影响因素,其次为既往复发情况和肿瘤大小,肿瘤数目是肿瘤进展的相关因素;T1G3膀胱尿路上皮癌需结合肿瘤数目、肿瘤大小、既往复发情况综合考虑治疗方案。

Analysis of recurrence and progression factors for T1G3 bladder urotheral carcinomas

Objective To discuss recurrence and progression factors for T1G3 bladder urotheral carcinomas and provide data for evidence based medicine.Methods We retrospectively reviewed 62 cases of T1G3 bladder cancer treated with transuretheral resection of bladder toumor(TURBT) followed by intravesical instillation between 1997 and 2009.Cumulative survival was analyzed by Kaplan-Meier method.Cox regression was used for univariate and multivariate analysis.Log-rank method was used for the significance test.The statistical difference was accepted when the p-value was lower than 0.05.Results Median follow-up period was 40 months(6-140 months).41 cases of intravesical recurrence(66.0%) were observed during follow-up.2-year and 5-year recurrence-free survival rates were 43.4% and 35.1%.14 cases of progression(23.0%) were observed during the follow-up period.2-year and 5-year progression-free survival rates were 86.4% and 83.5%.Significant factors for tumor recurrence and progression were analysised by Cox regression.Tumor multiplicity(RR=2.250),size(RR=1.039),recurrence(RR=2.162) were correlated with recurrence and tumor multiplicity(RR=3.695) was signi cantly correlated with progression on multivariate analysis.Conclusions Tumor multiplicity,size,history of recurrence were correlated with recurrence and tumor multiplicity was signi cantly correlated with progression.Tumor multiplicity,size,recurrence should be taken into account when we make therapy stratigies for T1G3 bladder urotheral carcinomas.