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目的 研究Ta期膀胱移行细胞癌(BTCC)经尿道电切加膀胱内灌注治疗的预后及相关因素。 方法 88例初发TaBTCC患者。男62例,女26例。平均年龄61岁(41 ~81岁)。G1 26例、G2 61例、G3 1例。单发者62例(G1 16例,G2 45例,G3 1例),多发者26例(G1 10例,G2 16例)。均行经尿道膀胱肿瘤电切术及膀胱内灌注治疗。平均随访113个月(56 ~168个月),分析肿瘤复发和进展情况及与初发肿瘤分化及数目间的关系。 结果 全组复发53例(60% )。单发肿瘤组16例G1 肿瘤者中复发4例(25% ), 45例G2 者中复发28例(62% ),总复发率为52% (32 /62);多发肿瘤组10例G1 中复发8例(80% ), 16例G2 者中复发12例(75% ),总复发率77% (20 /26)。原发肿瘤为多发者手术后复发率明显高于单发者(P<0. 01),单发肿瘤组中G2 患者复发率明显高于G1 者(P<0. 001)。多发肿瘤组中肿瘤分级与复发率无明显相关差异。G1 肿瘤组复发病例中无肿瘤进展, 40例G2 者中17例(42. 5% )复发时出现肿瘤进展,其中进展为T1G2 者12例,进展为T2G2 者5例。术后膀胱灌注噻替哌、丝裂霉素、卡介苗各组肿瘤复发率分别为75% (12 /16)、68% (30 /44)、40% (11 /27)。1例因癌特异死亡者为TaG3。 结论 多发的Ta膀胱移行细胞癌在经尿道膀胱肿瘤电术加膀胱内灌注治疗后有较高的复发?
Objective To investigate the prognosis and related factors of transurethral resection of bladder transitional cell carcinoma (BTCC) with intravesical instillation in Ta stage. Methods 88 cases of initial TaBTCC patients. There were 62 males and 26 females. The average age is 61 years old (41 ~ 81 years old). G1 26 cases, G2 61 cases, G3 1 case. There were 62 cases with single disease (16 in G1, 45 in G2, and 1 in G3), and 26 were predominant (G1 10 and G2 16). All transurethral resection of the bladder tumor and intravesical instillation. The average follow-up of 113 months (56 ~ 168 months), analysis of tumor recurrence and progression and the relationship between initial tumor differentiation and number. Results The whole group recurred in 53 cases (60%). Among the 16 tumor patients with G1 tumor recurrence in 4 patients (25%), the recurrence rate was 52% (32%) in 45 patients with G2 disease (28%) (62% Recurrence occurred in 8 patients (80%). Of the 16 patients with G2 disease, 12 patients (75%) relapsed, with a total recurrence rate of 77% (20/26). The recurrence rate was significantly higher in patients with multiple primary tumors after surgery (P <0.01). The recurrence rate was significantly higher in patients with single tumor than in patients with G1 (P <0.001). There was no significant correlation between tumor grade and relapse rate in multiple tumor group. There was no tumor progression in the G1 tumor recurrence group. Tumor progression occurred in 17 of 40 (42.5%) patients with recurrence, of which 12 progressed to T1G2 and 5 progressed to T2G2. The tumor recurrence rate of postoperative bladder infusion of thiotepa, mitomycin and BCG were 75% (12/16), 68% (30/44) and 40% (11/27) respectively. One case of cancer-specific death was TaG3. Conclusions Multiple bladder transitional cell carcinoma of the bladder has a higher recurrence after transurethral resection of bladder tumor and intravesical instillation.