非肌层浸润性膀胱癌患者首次经尿道膀胱肿瘤电切术后两年内复发的影响因素分析及风险预测

Factors influencing recurrence within two years after the first TURBT and risk prediction model for NMIBC

摘要

目的 分析非肌层浸润性膀胱癌（NMIBC）患者经尿道膀胱肿瘤电切术（TURBT）后两年肿瘤复发的危险因素，并建立风险预测模型，以帮助临床优化对NMIBC患者的监测及管理。方法 回顾性分析2020年1月-2022年10月于新疆医科大学第一附属医院泌尿外科首次确诊NMIBC并行TURBT的174例患者的临床资料，根据术后随访两年是否复发分为复发组（74例）和未复发组（100例）。采用单因素和多因素logistic回归分析，筛选出NMIBC患者行TURBT后两年内肿瘤复发的危险因素，并建立列线图，绘制校准曲线，再使用受试者工作特征曲线进行模型验证。结果 174例患者中有74例（42.53%）TURBT后两年复发。多因素logistic回归分析结果显示，高BMI、肿瘤低分化、多发肿瘤、肿瘤直径＞3 cm是NMIBC患者TURBT后两年内复发的危险因素（P＜0.05，OR≥1），术后即刻膀胱内灌注治疗为复发的保护因素（P＜0.05）。基于以上指标建立列线图模型，C-index为0.893（95%CI：0.851～0.938），受试者工作特征曲线下面积为0.894（95%CI：0.847～0.941）。验证预测模型的灵敏度为82.4%，特异度为83.0%。结论 基于BMI、肿瘤分期、分级、数量、直径以及术后即刻膀胱内灌注化疗建立的预测模型拟合度良好，可以为NMIBC患者行TURBT后两年内肿瘤复发的风险预测提供参考。

Abstract

Objective To analyze the risk factors of recurrence after transurethral resection of bladder tumor (TURBT) in patients with non-muscle-invasive bladder cancer (NMIBC), and establish a risk prediction model, so as to optimize the clinical detection and management of NMIBC. Methods A total of 174 patients with initial diagnosis of NMIBC who underwent TURBT in the First Affiliated Hospital of Xinjiang Medical University during Jan. 2020 and Oct. 2022 were followed up for 24 months, and were then divided into the recurrence group (n=74) and non-recurrence group (n=100). After univariate analysis and multivariate logistic regression, risk factors of recurrence were identified, a nomogram was established, and the calibration curve was plotted, which was verified with receiver operator characteristic (ROC) curve. Results The 2-year recurrence rate was 42.53%. Logistic regression showed high body mass index (BMI), poor differentiation, multiple tumors, and tumor diameter greater than 3 cm were risk factors of recurrence (P<0.05, OR≥1), while immediate postoperative intravesical instillation was a protective factor (P<0.05). The C-index of the nomogram was 0.893 (95%CI: 0.851-0.938), the area of ROC curve (AUC) was 0.894 (95%CI: 0.847-0.941), the sensitivity was 82.4%, and the specificity was 83.0%. Conclusion The prediction model based on BMI, tumor stage, grade, number, diameter, and immediate postoperative intravesical instillation fits well and can provide reference for predicting the risk of tumor recurrence.

关键词

非肌层浸润性膀胱癌 / 经尿道膀胱肿瘤电切术 / 复发因素 / 风险预测模型

Key words

non-muscle-invasive bladder cancer / transurethral resection of bladder tumor / factor of recurrence / risk prediction model

参考文献

[1] SIEGEL RL, GIAQUINTO AN, JEMAL A. Cancer statistics, 2024[J]. Ca: a Cancer J Clin, 2024, 74(1): 12-49.

[2] CHANG SS, BOORJIAN SA, CHOU R, et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline[J]. J Urol, 2016, 196(4): 1021-1029.

[3] 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.

[4] 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.

[5] 张丽红, 张飞, 王蓬勃, 等. 经尿道膀胱肿瘤电切术联合吡柔比星膀胱热灌注化疗治疗非浸润性膀胱癌的疗效研究[J]. 癌症进展, 2023, 21(3): 290-293.

[6] SILVERMAN DT, KOUTROS S, FIGUEROA JD, et al. Bladder cancer[M]// Schottenfeld and fraumeni cancer epidemiology and prevention, 4th ed. Oxford University Press, 2017: 977-996.

[7] 鲍一歌, 魏强. 经尿道膀胱肿瘤切除术的技术细节与优化[J]. 中华泌尿外科杂志, 2024, 45(5): 331-334.

[8] FREIFELD Y, GHANDOUR R, SINGLA N, et al. Intraoperative prophylactic intravesical chemotherapy to reduce bladder recurrence following radical nephroureterectomy[C]// Urologic Oncology: Seminars and Original Investigations. Elsevier, 2020, 38(9): 737.e11-737.e16.

[9] MICHAELI JC, BOCH T, ALBERS S, et al. Socio-economic burden of disease: survivorship costs for bladder cancer[J]. J Cancer Policy, 2022, 32: 100326.

[10] GALESLoot TE, GROTENHUIS AJ, 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.

[11] YANAGISAWA T, KAWADA T, VON DEIMLING M, et al. Repeat transurethral resection for non-muscle-invasive bladder cancer: an updated systematic review and meta-analysis in the contemporary era[J]. Eur Urol Focus, 2024, 10(1): 41-56.

[12] CUMBERBATCH MGK, FOERSTER B, CATTO JWF, et al. Repeat transurethral resection in non-muscle-invasive bladder cancer: a systematic review[J]. Eur Urol, 2018, 73(6): 925-933.

[13] GONTERO P, BIRTLE A, CAPOUN O, et al. European Association of Urology guidelines on non-muscle-invasive bladder cancer (TaT1 and carcinoma in situ)-a summary of the 2024 guidelines update[J]. Eur Urol, 2024, 86(6): 531-549.

[14] 焦海鑫, 金铎, 李大鹏. 吉西他滨联合丝裂霉素C膀胱灌注对膀胱癌患者经尿道膀胱肿瘤电切术后复发的影响[J]. 中国临床药理学杂志, 2023, 39(13): 1841-1845.

[15] QIU Y, JIANG Z, ZHANG J. Causal effects of BMI, waist circumference, and body fat percentage on the risk of bladder cancer: a mendelian randomization study[J]. Medicine, 2024, 103(20): e38231.

[16] 杨丽, 陶玲, 翁翔宇, 等. 肥胖导致的T细胞代谢障碍及相关疾病的研究进展[J]. 现代免疫学, 2024, 44(5): 459-464.

[17] BOIS K, ORLANDELLAR M, GIBSON JT, et al. Obesity diminishes response to PD-1-based immunotherapies in renal cancer[J]. J Immunother Cancer, 2020, 8(2): e000725.

[18] ANNETT S, MOORE G, ROBSON T. Obesity and cancer metastasis: molecular and translational perspectives[J]. Cancers, 2020, 12(12): 3798.