摘要
目的:探索非肌层浸润性膀胱癌(NMIBC)行经尿道膀胱肿瘤切除术(TURBT)联合卡介苗(BCG)灌注后复发的危险因素。方法:选取我院近5年行膀胱内BCG灌注患者作为研究对象,收集患者人口学特征、组织分级、TNM分期、肿瘤是否多发、是否有膀胱癌病史、BCG灌注后尿FISH结果、BCG灌注后复发和进展等临床资料。归纳和总结队列资料特征,应用Cox比例风险回归分析识别复发或进展的危险因素。结果:研究共纳入69例患者,男性58(84.06%)例,女性11(15.94%)例,中位年龄64(55.25~70.00)岁。根据BCG灌注后是否复发分为复发组10例和非复发组59例。BCG灌注后FISH阳性患者均复发,阴性患者均未复发。与非复发组比较,复发组在性别、年龄、膀胱内非BCG灌注史、BCG灌注不良反应等方面均未见明显差异(P>0.05),但TNM分期晚、组织分化差、有膀胱癌病史、肿瘤多发、BCG灌注后FISH阳性的患者更容易复发(P<0.05)。单因素Cox回归分析显示FISH阳性、TNM分期、肿瘤多发与肿瘤复发及进展密切相关(P<0.05),但组织学分级与疾病的进展未见相关性(P=0.064),而与复发具有相关性(P=0.038)。多因素Cox回归分析证实FISH阳性[HR=12.746,95%CI:3.828-79.541,P=0.002]是复发的独立危险因素。结论:FISH阳性、TNM分期、肿瘤多发是膀胱癌复发及进展的危险因素。电切术后行BCG灌注且FISH阴性患者的随访间隔可以适当延长,阳性患者推荐增加镜检频率。
Objective:To explore the risk factors for recurrence of non-muscular invasive bladder cancer(NMIBC)after transurethral resection of bladder tumour(TURBT)combined with Bacillus Calmette-Guérin(BCG)perfusion.Methods:Patients with intravesical BCG perfusion in our hospital in recent 5 years were selected as subjects.Clinical data including basic demographic characteristics of patients,fluorescence in situ hybridization(FISH)test results after BCG perfusion,TNM stage,tumor histological grade,multiple tumors,history of bladder cancer,recurrence and progression after BCG perfusion were collected.The characteristics of queue data were generalized and summarized.Cox proportional risk regression analyses were used to identify risk factors for recurrence or progression.Results:A total of 69 patients were enrolled,including 58(84.06%)males and 11(15.94%)females,with a median age of 64(55.25-70.00)years.According to the recurrence or not after BCG perfusion,the patients were divided into recurrence group(n=10)and non-recurrence group(n=59).After BCG perfusion,all patients withpositive FISH recurred,while none of the patients with negative FISH recurred.There were no significant differences in gender,age,non-BCG perfusion history in bladder and BCG adverse perfusion reactions between the non-recurrent group and the recurrent group(P>0.05),but patients with later TNM stage,poor tissue differentiation,bladder cancer history,multiple tumors,and positive FISH after BCG perfusion were more likely to relapse(P<0.05).Univariate Cox proportional risk regression analysis showed that positive FISH after BCG perfusion,TNM stage,and multiple tumor were closely correlated with tumor recurrence and progression(P<0.05),but there was no correlation between histological grade and disease progression(P=0.064).The histological grade was correlated with disease recurrence(P=0.038).Multivariate Cox proportional hazard regression confirmed that positive FISH after BCG perfusion was an independent risk factor for recurrence[HR:12.746,95%CI:3.828-79.541,P=0.002].Conclusions:Positive FISH after BCG perfusion,TNM clinical stage and multiple tumors were risk factors for recurrence and progression of bladder cancer.After BCG perfusion,the follow-up interval of patients with negative FISH can be appropriately extended,while patients with positive FISH should be followed closely and the follow-up interval should be appropriately shortened.
作者
柯春锦
龙恭伟
刘正浩
阮伟强
李乐
田继华
甘家骅
曾星
胡志全
杨春光
Ke Chunjin;Long Gongwei;Liu Zhenghao;Ruan Weiqiang;Li Le;Tian Jihua;Gan Jiaye;Zeng Xin;Hu Zhiquan;Yang Chunguang(Department of Urology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《微创泌尿外科杂志》
2022年第4期252-257,共6页
Journal of Minimally Invasive Urology
关键词
非肌层浸润性膀胱癌
TURBT
BCG灌注
荧光原位杂交
预后
non-muscular invasive bladder cancer
transurethral resection of bladder tumour
Bacillus CalmetteGuérin perfusion
fluorescence in situ hybridization
prognosis
作者简介
通信作者:胡志全,huzhiquan2000@163.com
