非肌层浸润性膀胱癌行初次经尿道膀胱肿瘤电切术的术后复发危险因素分析

唐多才; 周术奎; 张桂银; 刘磊; 廖洪

doi:10.19401/j.cnki.1007-3639.2023.05.008

您当前的位置：

首页 >

文章列表页 >

非肌层浸润性膀胱癌行初次经尿道膀胱肿瘤电切术的术后复发危险因素分析

论著 | 更新时间：2025-12-31

- 非肌层浸润性膀胱癌行初次经尿道膀胱肿瘤电切术的术后复发危险因素分析
- Analysis of risk factors of recurrence in non-muscle invasive bladder cancer patients after initial transurethral resection of bladder tumor
- 中国癌症杂志 2023年33卷第5期页码：478-483
- 作者机构：
  
  1. 成都医学院，四川成都 610500
  2. 电子科技大学附属肿瘤医院（四川省肿瘤医院 · 研究所）泌尿外科，四川成都 610041
- 作者简介：
  
  [ "唐多才（ORCID: 0000-0001-9073-0637），硕士在读。" ]
  廖洪（ORCID: 0000-0001-8372-7165），硕士，主任医师，电子科技大学附属肿瘤医院副院长。
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2023.05.008
  中图分类号： R737.14
- 收稿：2022-08-26，
  
  修回：2022-11-17，
  
  纸质出版：2023-05-30
- 稿件说明：
移动端阅览
唐多才, 周术奎, 张桂银, 等. 非肌层浸润性膀胱癌行初次经尿道膀胱肿瘤电切术的术后复发危险因素分析[J]. 中国癌症杂志, 2023,33(5):478-483.

Duocai TANG, Shukui ZHOU, Guiyin ZHANG, et al. Analysis of risk factors of recurrence in non-muscle invasive bladder cancer patients after initial transurethral resection of bladder tumor[J]. China Oncology, 2023, 33(5): 478-483.
唐多才, 周术奎, 张桂银, 等. 非肌层浸润性膀胱癌行初次经尿道膀胱肿瘤电切术的术后复发危险因素分析[J]. 中国癌症杂志, 2023,33(5):478-483. DOI： 10.19401/j.cnki.1007-3639.2023.05.008.

Duocai TANG, Shukui ZHOU, Guiyin ZHANG, et al. Analysis of risk factors of recurrence in non-muscle invasive bladder cancer patients after initial transurethral resection of bladder tumor[J]. China Oncology, 2023, 33(5): 478-483. DOI： 10.19401/j.cnki.1007-3639.2023.05.008.

摘要

背景与目的：

非肌层浸润性膀胱癌（non-muscle invasive bladder cancer，NMIBC）患者行经尿道膀胱肿瘤电切术（transurethral resection of bladder cancer，TURBT）的术后复发率较高，分析NMIBC患者行初次TURBT术后复发危险因素的相关研究较少。本研究旨在分析NMIBC患者行初次TURBT的术后复发危险因素，有助于筛选复发高危人群，预防性采取相应的干预措施。

方法：

选取2015年12月—2020年5月在电子科技大学附属肿瘤医院行初次TURBT治疗的NMIBC患者197例，随访24~77个月，根据是否复发分为复发组（48例）和非复发组（149例）。对两组临床资料进行单因素分析，将单因素分析差异有统计学意义的指标纳入多因素logistic回归分析，筛选TURBT术后复发的可能危险因素。

结果：

单因素分析显示，未复发组初治时有肉眼血尿、二次电切、肿瘤T分期为T

期、肿瘤分级为高级别、肿瘤多发及未行即刻膀胱内灌注化疗的占比低于复发组，差异有统计学意义（

0.05）。两组的性别、年龄、肿瘤家族史、吸烟史、肿瘤大小及后续膀胱内灌注化疗对比差异无统计学意义（

0.05）。两组中性粒细胞/淋巴细胞、中性粒细胞×血红蛋白/淋巴细胞的受试者工作特征（receiver operating characteristic，ROC）曲线显示差异无统计学意义（

0.05）。多因素logistic回归分析显示，肿瘤T分期为T

期、肿瘤分级为高级别、肿瘤多发及未行即刻膀胱内灌注化疗为NMIBC患者初次TURBT术后复发的独立危险因素（

0.05，OR

1）。

结论：

NMIBC患者行初次TURBT术后复发与肿瘤分期、肿瘤分级、肿瘤数目、是否行即刻膀胱内灌注化疗密切相关，临床上可以采取对应的干预措施，降低患者术后的复发率。

Abstract

Background and purpose:

The recurrence rate of non-muscle invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor (TURBT) is high. There are few studies on the risk factors of recurrence in NMIBC patients after initial TURBT. Our study aimed to screen the high-risk population and take corresponding preventive intervention measures by analyzing the risk factors of recurrence in NMIBC patients after initial TURBT.

Methods:

A total of 197 NMIBC patients who received initial TURBT in The Cancer Hospital of the University of Electronic Science and Technology of China from December 2015 to May 2020 were selected and followed up for 24 to 77 months. Patients were divided into recurrence group (48 cases) and non-recurrence group (149 cases) according to the results. Univariate analysis was performed on the cl

inical data of the two groups

and the indicators with statistical significance were included in the multivariate logistic regression analysis to screen the possible risk factors of recurrence.

Results:

Univariate analysis showed that the difference was statistically significant between two groups in gross hematuria

secondary resection

T1 stage

high grade tumor

multiple tumor and lack of immediate intravesical therapy (

0.05).There was no significant difference in gender

age

family history of tumor

smoking history

tumor size and subsequent intravesical therapy between two groups (

0.05). The receiver operating characteristic (ROC) curves of the ratio of neutrophils to lymphocytes and the ratio of neutrophils and hemoglobin to lymphocytes showed no statistically significant difference between two groups (

0.05). Multivariate logistic regression analysis showed that T1 stage

high grade tumor

multiple tumor and lack of immediate intravesical therapy were independent risk factors of recurrence in NMIBC patients after initial TURBT (

0.05

1).

Conclusion:

The recurrence of NMIBC patients after initial TURBT is closely related to tumor stage

tumor grade

tumor number and immediate intravesical therapy. Corresponding intervention measures can be taken to reduce the postoperative recurrence rate in initial NMIBC patients.

关键词

Keywords

references

SIEGEL R L , MILLER K D , JEMAL A . Cancer statistics, 2016 [J ] . CA A Cancer J Clin , 2016 , 66 ( 1 ): 7 - 30 . DOI: 10.3322/caac.21332 http://doi.org/10.3322/caac.21332 http://doi.wiley.com/10.3322/caac.21332 http://doi.wiley.com/10.3322/caac.21332

ZHANG J , WANG Y Y , WENG H , et al . Management of non-muscle-invasive bladder cancer: quality of clinical practice guidelines and variations in recommendations [J ] . BMC Cancer , 2019 , 19 ( 1 ): 1054 . DOI: 10.1186/s12885-019-6304-y http://doi.org/10.1186/s12885-019-6304-y

POWLES T , BELLMUNT J , COMPERAT E , et al . Bladder cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up [J ] . Ann Oncol , 2022 , 33 ( 3 ): 244 - 258 . DOI: 10.1016/j.annonc.2021.11.012 http://doi.org/10.1016/j.annonc.2021.11.012 https://linkinghub.elsevier.com/retrieve/pii/S0923753421048274 https://linkinghub.elsevier.com/retrieve/pii/S0923753421048274

BABJUK M , BURGER M , CAPOUN O , et al . European association of urology guidelines on non-muscle invasive bladder cancer (T a , T 1 , and carcinoma in situ ) [J ] . Eur Urol , 2022 , 81 ( 1 ): 75 - 94 . DOI: 10.1016/j.eururo.2021.08.010 http://doi.org/10.1016/j.eururo.2021.08.010 https://linkinghub.elsevier.com/retrieve/pii/S0302283821019783 https://linkinghub.elsevier.com/retrieve/pii/S0302283821019783

WANG T W , YUAN H , DIAO W L , et al . Comparison of gemcitabine and anthracycline antibiotics in prevention of superficial bladder cancer recurrence [J ] . BMC Urol , 2019 , 19 ( 1 ): 90 . DOI: 10.1186/s12894-019-0530-0 http://doi.org/10.1186/s12894-019-0530-0

ZHENG R S , ZHANG S W , ZENG H M , et al . Cancer incidence and mortality in China, 2016 [J ] . J Natl Cancer Cent , 2022 , 2 ( 1 ): 1 - 9 .

LU J L , XIA Q D , LU Y H , et al . Efficacy of intravesical therapies on the prevention of recurrence and progression of non-muscle invasive bladder cancer: a systematic review and network meta-analysis [J ] . Cancer Med , 2020 , 9 ( 21 ): 7800 - 7809 . DOI: 10.1002/cam4.v9.21 http://doi.org/10.1002/cam4.v9.21 https://onlinelibrary.wiley.com/toc/20457634/9/21 https://onlinelibrary.wiley.com/toc/20457634/9/21

SIKIC D , ECKSTEIN M , WEYERER V , et al . High expression of ERBB2 is an independent risk factor for reduced recurrence-free survival in patients with stage T 1 non-muscle invasive bladder cancer [J ] . Urol Oncol , 2022 , 40 ( 2 ): 63.e9-63.63.e18.

SYLVESTER R J , VAN DER MEIJDEN A P , OOSTERLINCK W , et al . Predicting recurrence and progression in individual patients with stage T a T 1 bladder cancer using EORTC risk tables: a combined analysis of 2 596 patients from seven EORTC trials [J ] . Eur Urol , 2006 , 49 ( 3 ): 466 - 465 ; discussion 475-477. DOI: 10.1016/j.eururo.2005.12.031 http://doi.org/10.1016/j.eururo.2005.12.031 https://linkinghub.elsevier.com/retrieve/pii/S0302283805008523 https://linkinghub.elsevier.com/retrieve/pii/S0302283805008523

杨庆良 , 陈志峰 , 王军 , 等 . 非肌层浸润性膀胱癌患者经尿道膀胱肿瘤电切术后复发的影响因素 [J ] . 实用癌症杂志 , 2022 , 37 ( 2 ): 309 - 311 .

YANG Q L , CHEN Z F , WANG J , et al . Factors affecting recurrence of non-myometrial invasive bladder cancer after transurethral resection of bladder tumor [J ] . Pract J Cancer , 2022 , 37 ( 2 ): 309 - 311 .

董建庭 . 非肌层浸润性膀胱癌患者经尿道膀胱肿瘤电切术治疗后复发的现状及其危险因素分析 [J ] . 中国药物与临床 , 2022 , 22 ( 3 ): 223 - 226 .

DONG J T . Recurrence of non-muscle invasive bladder cancer and risk factors in patients after transurethral resection of bladder tumor [J ] . Chin Remedies & Clin , 2022 , 22 ( 3 ): 223 - 226 .

薛炜 , 邱建新 , 桑楠 , 等 . 影响非肌层浸润性膀胱癌患者经尿道膀胱肿瘤电切术后复发的相关因素分析 [J ] . 实用医院临床杂志 , 2019 , 16 ( 5 ): 30 - 33 .

XUE W , QIU J X , SANG N , et al . Analysis of related factors influencing recurrence of patients with non-muscle invasive bladder cancer after transurethral resection of bladder tumor [J ] . Pract J Clin Med , 2019 , 16 ( 5 ): 30 - 33 .

白恒舟 , 乔保平 . 200例非肌层浸润性膀胱癌复发及进展的危险因素分析 [J ] . 河南外科学杂志 , 2017 , 23 ( 6 ): 39 - 41 .

BAI H Z , QIAO B P . Analysis of risk factors for recurrence and progression of non-muscular invasive bladder cancer in 200 cases [J ] . Henan J Surg , 2017 , 23 ( 6 ): 39 - 41 .

ZHANG Y Q , BREKKEN R A . Direct and indirect regulation of the tumor immune microenvironment by VEGF [J ] . J Leukoc Biol , 2022 , 111 ( 6 ): 1269 - 1286 . DOI: 10.1002/JLB.5RU0222-082R http://doi.org/10.1002/JLB.5RU0222-082R https://academic.oup.com/jleukbio/article/111/6/1269/6885169 https://academic.oup.com/jleukbio/article/111/6/1269/6885169

苟泓燊 , 郑红岗 , 段中琪 . 经尿道膀胱肿瘤电切术术后即刻表柔比星灌注化疗在非肌层浸润性膀胱癌患者中的应用效果 [J ] . 癌症进展 , 2021 , 19 ( 22 ): 2343 - 2346 .

GOU H S , ZHENG H G , DUAN Z Q . Effect of immediate epirubicin infusion chemotherapy after transurethral resection of bladder tumor in patients with non-muscular invasive bladder cancer [J ] . Oncol Prog , 2021 , 19 ( 22 ): 2343 - 2346 .

CUMBERBATCH M G K , FOERSTER B , CATTO J W F , et al . Repeat transurethral resection in non-muscle invasive bladder cancer: a systematic review [J ] . Eur Urol , 2018 , 73 ( 6 ): 925 - 933 . DOI: 10.1016/j.eururo.2018.02.014 http://doi.org/10.1016/j.eururo.2018.02.014 https://linkinghub.elsevier.com/retrieve/pii/S0302283818301210 https://linkinghub.elsevier.com/retrieve/pii/S0302283818301210

GONTERO P , SYLVESTER R , PISANO F , et al . The impact of re-transurethral resection on clinical outcomes in a large multicentre cohort of patients with T 1 high-grade/grade 3 bladder cancer treated with bacille Calmette-Guérin [J ] . BJU Int , 2016 , 118 ( 1 ): 44 - 52 . DOI: 10.1111/bju.13354 http://doi.org/10.1111/bju.13354 https://onlinelibrary.wiley.com/doi/10.1111/bju.13354 https://onlinelibrary.wiley.com/doi/10.1111/bju.13354

FLAIG T W , SPIESS P E , AGARWAL N , et al . Bladder cancer, version 3. 2020, NCCN clinical practice guidelines in oncology [J ] . J Natl Compr Canc Netw , 2020 , 18 ( 3 ): 329 - 354 . DOI: 10.6004/jnccn.2020.0011 http://doi.org/10.6004/jnccn.2020.0011 https://jnccn.org/view/journals/jnccn/18/3/article-p329.xml https://jnccn.org/view/journals/jnccn/18/3/article-p329.xml

MANO R , BANIEL J , SHOSHANY O , et al . Neutrophil-to-lymphocyte ratio predicts progression and recurrence of non-muscle invasive bladder cancer [J ] . Urol Oncol , 2015 , 33 ( 2 ): 67.e1-67.e7.

HEDRICK C C , MALANCHI I . Neutrophils in cancer: Heterogeneous and multifaceted [J ] . Nat Rev Immunol , 2022 , 22 ( 3 ): 173 - 187 . DOI: 10.1038/s41577-021-00571-6 http://doi.org/10.1038/s41577-021-00571-6

BULUT G , OZDEMIR Z N . Prognostic significance of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in metastatic colorectal cancer [J ] . J Gastrointest Canc , 2022 , 53 ( 1 ): 1 - 6 . DOI: 10.1007/s12029-021-00616-y http://doi.org/10.1007/s12029-021-00616-y

ZHENG X Q , FAN H , LIU Y , et al . Hypoxia boosts aerobic glycolysis in carcinoma: a complex process for tumour development [J ] . Curr Mol Pharmacol , 2022 , 15 ( 3 ): 487 - 501 . DOI: 10.2174/1874467214666210811145752 http://doi.org/10.2174/1874467214666210811145752 https://www.eurekaselect.com/195565/article https://www.eurekaselect.com/195565/article

ZHAO R N , SHAN J H , NIE L H , et al . The predictive value of the ratio of the product of neutrophils and hemoglobin to lymphocytes in non-muscular invasive bladder cancer patients with postoperative recurrence [J ] . J Clin Lab Anal , 2021 , 35 ( 8 ): e23883.

CHENG X F , ZHOU X C , YI M , et al . Preoperative aspartate transaminase/alanine transaminase ratio as a prognostic biomarker in primary non-muscle invasive bladder cancer: a propensity score-matched study [J ] . BMC Urol , 2021 , 21 ( 1 ): 136 . DOI: 10.1186/s12894-021-00901-9 http://doi.org/10.1186/s12894-021-00901-9

HUANG J G , ZHAO L W , WANG K , et al . Controlling nutritional status score evaluates prognosis in patients with non-muscle invasive bladder cancer [J ] . Cancer Control , 2021 , 28 : 10732748211021078.

WANG Z Y , GAO W S , LI J , et al . Development and validation of a novel recurrence risk stratification for initial non-muscle invasive bladder cancer in the Han Chinese population [J ] . J Cancer , 2020 , 11 ( 7 ): 1668 - 1678 . DOI: 10.7150/jca.38649 http://doi.org/10.7150/jca.38649

GALESLOOT T E , GROTENHUIS A J , KOLEV D , et al . Genome-wide meta-analysis identifies novel genes associated with recurrence and progression in non-muscle invasive bladder cancer [J ] . Eur Urol Oncol , 2022 , 5 ( 1 ): 70 - 83 .

DALLA E , PICCO R , NOVARA G , et al . Identification of a gene signature for the prediction of recurrence and progression in non-muscle invasive bladder cancer [J ] . Mol Biomed , 2022 , 3 ( 1 ): 9 . DOI: 10.1186/s43556-022-00069-0 http://doi.org/10.1186/s43556-022-00069-0

浏览量

1118

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

癌胚抗原和糖类抗原19-9对Ⅱ~Ⅲ期结肠癌复发的预测价值

87例唾液腺导管癌患者的治疗策略与预后分析：一项回顾性队列研究

卡瑞利珠单抗联合化疗及靶向治疗在复发、转移及初治晚期宫颈癌中的疗效与安全性分析：一项回顾性队列研究

乳腺癌改良根治术后感染的病原学特征、影响因素及炎症因子分析

甲状腺癌的流行病学现状及其影响因素研究进展