经尿道二次电切在pT<sub>1</sub>期非肌层浸润性膀胱癌的预后价值研究

doi:10.3877/cma.j.issn.1674-3253.2022.04.007

目的

评估常规二次经尿道膀胱肿瘤切除术（STURBT）对初诊T₁期非肌层浸润性膀胱癌（NMIBC）患者远期预后的价值。

方法

本研究回顾性分析了在我院接受治疗的256例pT₁期NMIBC患者，接受经尿道膀胱肿瘤电切术（TURBT）患者126例，接受二次TURBT（STURBT）的患者130例。通过查阅病历资料和随访的方式评估两种手术方式的预后疗效。我们记录了两组患者疾病复发及死亡情况。最后，总的疾病复发率（DRR）、疾病特异性死亡率（DSM）及2年、4年和6年无复发生存率（RFS）和总生存率（OS）作为两组对比分析指标。

结果

两组患者随访时间为6年，相比较TURBT组，STURBT组的DRR（42.1% vs 61.9%，P=0.001）和DSM（23.1% vs 35.7%，P=0.026）均显著降低；4年和6年的RFS（59.2% vs 44.4%，P=0.018；55.4% vs 38.1%，P=0.006）明显升高；6年OS（76.2% vs 64.3%，P=0.038）也明显升高。利用Kaplan-Meier法构建的RFS、OS曲线显现出差异有统计学意义（RFS：P=0.001；OS：P=0.029），STURBT组RFS、OS均优于TURBT组。

结论

pT₁期NMIBC患者STURBT的预后价值，不仅对患者RFS有利，而且对长期OS有利。

关键词: 膀胱癌, 二次电切, 生存率, 预后

Objective

To evaluate the effect of routine second transurethral cystectomy (STURBT) on the long-term prognosis of newly diagnosed pT₁ non-muscular invasive bladder cancer (NMIBC).

Methods

This study retrospectively analyzed 256 patients with T₁ stage NMIBC who received treatment in our hospital, including 126 patients who received TURBT and 130 patients who received STURBT. The prognosis of the two surgical methods was evaluated by medical records and following up. Recurrence and death were recorded in both groups. Finally, the total rate of disease recurrence (DRR), disease-specific mortality (DSM), 2-year, 4-year and 6-year recurrence free survival (RFS) and overall survival (OS) were compared and analyzed as indicators of the two groups.

Results

The follow-up time of the two groups was 6 years, and the DRR (42.1% vs 61.9%, P=0.001) and DSM (23.1 vs 35.7%, P=0.026) of the STURBT group were significantly reduced compared with TURBT group. 4-year and 6-year RFS (59.2% vs 44.4%, P=0.018; 55.4% vs 38.1%, P=0.006) significantly increased; 6-year OS (76.2 % vs 64.3%, P=0.038) was also significantly higher. The RFS and OS curves constructed by Kaplan-Meier method showed statistical difference (RFS: P=0.001; OS: P=0.029), RFS and OS in STURBT group were superior to those in TURBT group.

Conclusion

The prognostic value of STURBT in pT₁ NMIBC patients was not only beneficial to patients' RFS, but also to patients' long-term OS.

Key words: Bladder cancer, Secondary electrotomy, Overall survival, Prognosis

图1 非肌层浸润性膀胱癌患者入组研究流程图

图2 非肌层浸润性膀胱癌患者无复发生存率和总生存率的Kaplan-Meier曲线

表1 两组患者的人口统计学数据和基线肿瘤特征

组别	例数	年龄(岁)	性别(例)		肿瘤大小(例)				肿瘤分级(例)
			男	女	单发		多发		低	高
			男	女	<3 cm	≥3 cm	<3 cm	≥3 cm	低	高
TURBT组	126	64±19	110	16	29	12	52	33	69	57
STURBT组	130	64±17	112	18	32	11	49	38	67	63
统计值		t=0.457	χ²=0.073		χ²=0.143		χ²=0.418		χ²=0.267
P值		0.638	0.787		0.705		0.518		0.605

表1 两组患者的人口统计学数据和基线肿瘤特征

组别	例数	年龄(岁)	性别(例)		肿瘤大小(例)				肿瘤分级(例)
			男	女	单发		多发		低	高
			男	女	<3 cm	≥3 cm	<3 cm	≥3 cm	低	高
TURBT组	126	64±19	110	16	29	12	52	33	69	57
STURBT组	130	64±17	112	18	32	11	49	38	67	63
统计值		t=0.457	χ²=0.073		χ²=0.143		χ²=0.418		χ²=0.267
P值		0.638	0.787		0.705		0.518		0.605

表2 研究组的预后和生存参数

组别	例数	复发[例(%)]	疾病特异性死亡[例(%)]	无复发生存率(%)			总生存率(%)
组别	例数	复发[例(%)]	疾病特异性死亡[例(%)]	2年	4年	6年	2年	4年	6年
TURBT组	126	78（61.9）	45（35.7）	53.2	44.4	38.1	90.5	77.0	64.3
STURBT组	130	53（42.1）	30（23.1）	64.6	59.2	55.4	90.8	80.8	76.2
χ²值		11.439	4.933	3.462	5.604	7.681	0.006	0.551	4.318
P值		0.001	0.026	0.063	0.018	0.006	0.936	0.458	0.038

表2 研究组的预后和生存参数

组别	例数	复发[例(%)]	疾病特异性死亡[例(%)]	无复发生存率(%)			总生存率(%)
组别	例数	复发[例(%)]	疾病特异性死亡[例(%)]	2年	4年	6年	2年	4年	6年
TURBT组	126	78（61.9）	45（35.7）	53.2	44.4	38.1	90.5	77.0	64.3
STURBT组	130	53（42.1）	30（23.1）	64.6	59.2	55.4	90.8	80.8	76.2
χ²值		11.439	4.933	3.462	5.604	7.681	0.006	0.551	4.318
P值		0.001	0.026	0.063	0.018	0.006	0.936	0.458	0.038

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Prognostic value of transurethral secondary electrotomy in pT₁ stage non-muscular invasive bladder cancer

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Prognostic value of transurethral secondary electrotomy in pT1 stage non-muscular invasive bladder cancer

Prognostic value of transurethral secondary electrotomy in pT₁ stage non-muscular invasive bladder cancer