根治性膀胱切除术前完整经尿道膀胱肿瘤切除术对病理T2期患者预后的影响

Impact of complete transurethral resection of bladder tumor before radical cystectomy on prognosis of patients with T2 bladder cancer

    摘要
  • 摘要:
      目的  探讨根治性膀胱切除术（radical cystectomy，RC）前完整经尿道膀胱肿瘤切除术（transurethral resection of bladder tumor，TURBT）能否提高病理T2期膀胱癌患者的治疗效果。
      方法  回顾性分析2008年1月至2018年12月纳入的94 例于中山大学附属肿瘤医院行RC术后病理分期为T2N0M0患者的临床病理资料，分为完整TURBT组52例和非完整TURBT组42例。完整TURBT定义为术中膀胱镜检查及RC标本中无肉眼可见的病变。比较两组患者的无疾病生存（disease free survival，DFS）时间，分析与生存预后相关的独立预测因子。
      结果  肿瘤个数的中位数为1个，肿瘤大小的中位数为3 cm，中位随访时间为42.7 个月，94 例患者中16 例出现复发。完整TURBT组中11例患者RC术后病理降期，完整TURBT与肿瘤大小（P=0.021）、组织学变异（P=0.015）和降期（P=0.001）相关。年龄是DFS的独立预测因子（P=0.034），完整TURBT（P=0.165）、降期（P=0.740）与DFS无显著性相关。
      结论  行RC前完整TURBT与降期有关，但不会改善病理T2期膀胱癌患者的治疗效果。

     

    Abstract:
      Objective  To investigate the role of complete transurethral resection of bladder tumor (TURBT) before radical cystectomy (RC) in T stage 2 (T2) bladder cancer.
      Methods  A total of 94 patients who underwent RC with pathological stage T2N0M0 in Sun Yat-sen University Cancer Center between January 2008 and December 2018 were retrospectively examined and assigned into two groups: complete (n=52) and incomplete (n=42) TURBT. The inclusion criterion for the complete TURBT group was no visible lesion on endoscopy after TURBT or RC. The disease-free survival of the two groups was compared, and independent predictors of survival were evaluated.
      Results  The median number and size of tumors were 1 and 3 cm, respectively. With a median follow-up of 42.7 months, 16 of 94 patients experienced recurrence. Complete TURBT was related to tumor size (P=0.021), histological variants (P=0.015), and down staging (P=0.001). Age was an independent predictor of disease-free survival (P=0.034), and complete TURBT and down staging were not independent predictors of disease-free survival (DFS) (P=0.165 and 0.740, respectively).
      Conclusions  Complete TURBT is related to an increased rate of down staging before RC, and it was not associated with better oncological outcomes for patients with T2 bladder cancer.

     

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