二次电切治疗的疗效和二次电切残余肿瘤风险分析

发布时间：2018-02-21 12:50

本文关键词： 膀胱癌二次经尿道电切预后免疫组化肿瘤标志物评分模型　出处：《中南大学》2014年博士论文　论文类型：学位论文

【摘要】：目的：非肌层浸润型膀胱癌(NMIBC)常规手术治疗后复发、进展率高。第二次经尿道膀胱肿瘤电切运用于临床后,NMIBC预后得到改善。但在国内,尚缺乏足够的相关临床资料。本研究旨在探究我院reTUR治疗情况以及其对患者术后预后的影响。方法：回顾性收集2008年至2013年满足纳入指征的NMIBC患者资料,利用K-M生存曲线、多因素COX比例风险模型分析reTUR对患者预后的影响。结果：共计81位接受单次电切,36位接受reTUR的患者被纳入研究。reTUR组中,残余肿瘤率为44.4%(16/36)。术后2年时,54%单次TUR组患者膀胱癌复发,而接受ReRUR者36%膀胱癌复发(p0.05)。术后2年时,25%单次TUR组患者膀胱癌进展,而接受ReRUR者仅11%膀胱癌进展(p=0.157)。多因素分析中,reTUR为无复发生存率的独立预测因子(HR=0.35,95%CI=0.17-0.71p=0.003), reTUR对无进展生存率无统计学意义(HR=0.51,95%CI=0.17-1.51, p=0.22)。结论：reTUR可减少膀胱癌患者术后复发。尽管无统计学意义,reTUR可能影响术后疾病进展,其确切影响仍有待于进一步研究。目的：NMIBC是一类异质性很高的肿瘤。尽管reTUR可明显改善膀胱癌患者预后,但并非满足reTUR适应症的所有膀胱癌患者都有残余肿瘤,都从reTUR中受益。因此,我们设计这一章节试图探究其他临床和分子指标是否对reTUR有指导作用。方法：回顾性收集2008年至2013年接受reTUR的NMIBC患者资料,并对所有患者第一次电切的肿瘤标本行免疫组织化学测定P53、Ki67、VEGF、E-cadheri、n survivin表达。利用多因素logistic分析建立残余肿瘤的风险方程。根据风险方程回归系数建立残余肿瘤风险评分模型。结果：残余肿瘤的风险模型为：logitP=-1.85+2.29X1+1.21X2+1.28X3(X1为肿瘤大小,X2为p53,X3为E-cadherin)。成功建立残余肿瘤风险模型,低危组、中危组、高危组肿瘤残余率分别为9.1%、27.3%、85.7%。低危-中高危分类的敏感度、特异度(93.8%、50%)优于单独按肿瘤大小(50%、90%)、p53(50%、75%)、E-cadherin分类(62.5、75%)。结论：肿瘤大小、p53、E-cadherin为膀胱肿瘤电切术后肿瘤残余风险的独立危险因素。通过风险评分建模可以将患者分为低危组、中危组、高危组,更好地划分了患者术后肿瘤残余的风险,且采用风险模型明显优于单独采用单个因素评价残余肿瘤风险。对于高危人群,强烈建议reTUR,对于低危人群,可酌情考虑是否需reTUR。
[Abstract]:Objective: to improve the prognosis of NMIBC after the second transurethral resection of bladder tumor, the recurrence rate of NMIBCwas high after conventional surgical treatment of NMIBC.However, the prognosis of NMIBC was improved after the second transurethral resection of bladder tumor. The purpose of this study was to investigate the effect of reTUR treatment on postoperative prognosis in our hospital. Methods: from 2008 to 2013, the data of NMIBC patients who satisfied with the indications were collected retrospectively. K-M survival curve and multivariate COX proportional risk model were used to analyze the influence of reTUR on the prognosis of the patients. Results: a total of 81 patients underwent single electrosurgical resection and 36 patients with reTUR were included in the study. The residual tumor rate was 44.440% 16 / 36% in the TUR group and 54% of the patients in the single TUR group recurred at 2 years after operation. The recurrence rate of bladder cancer in 36% patients with ReRUR was p0.05. The progression of bladder cancer was observed in 25% of patients with single TUR 2 years after operation. In multivariate analysis, ReRUR was an independent predictor of recurrence free survival. ReTUR was 0.17-0.71p0.003. There was no significant difference between reTUR and progression survival rate (CI: 0.17-1.51, p0.22). Conclusion the recurrence of bladder cancer can be reduced by 1: reTUR, although no statistical significance may affect the progression of the disease, the exact effect remains to be further studied. [WT5 "HZ] [WT5" BZ] [WT5 "BZ] [WT5" BZ]. Objective: NMIBC is a class of highly heterogeneous tumors. Although reTUR can significantly improve the prognosis of bladder cancer patients, not all bladder cancer patients who meet the reTUR indication have residual tumors and benefit from reTUR. We designed this chapter to explore whether other clinical and molecular indicators can guide reTUR. Methods: the data of NMIBC patients receiving reTUR from 2008 to 2013 were collected retrospectively. The expression of P53 / Ki67 VEGF- E-cadherion survivin was determined by immunohistochemistry. The risk equation of residual tumor was established by multivariate logistic analysis. The risk scoring model of residual tumor was established according to the regression coefficient of risk equation. Results: the risk model of residual tumor was: 1: logit Pn-1.85 2.29X1 1.21X2 1.28X3X1: tumor size: X2: p53X3 was E-cadherin.A risk model of residual tumor was successfully established. The residual rate of tumor in low risk group, middle risk group and high risk group was 9.127.35.7.The sensitivity of low risk to middle high risk classification was 9.127.35.7. The specificity is better than that according to the size of the tumor alone. Conclusion: p53 E-cadherin is an independent risk factor of residual tumor risk after electroresection of bladder tumor. Patients can be divided into low risk group, middle risk group and high risk group by risk score modeling. The risk model is superior to single factor in evaluating residual tumor risk. ReTURs are strongly recommended for high risk population and reTURs should be considered as appropriate for low risk groups.
【学位授予单位】：中南大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R737.14

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