合并低级别成分对高级别非肌层浸润性膀胱癌预后的影响

Impact of coexistent low-grade components on the prognosis of high-grade non- muscle invasive bladder cancer

摘要

目的：评估合并低级别成分对高级别单发原发性非肌层浸润性膀胱癌（non-muscle invasive bladder cancer，NMIBC）患者预后的影响。方法：选择2015年1月至2019年12月在北京大学人民医院接受经尿道膀胱肿瘤切除手术（Transurethral resection of bladder tumor，TURBT）的原发性且单发的高级别 NMIBC 患者的病例资料进行回顾性分析。所有患者均于术后24 h 内接受单次灌注化疗，并接受足量辅助灌注化疗。所有患者均严格依据随访计划接受随访。结果：共纳入 167 名患者，35名患者为混合性高级别肿瘤（mixed high-grade，mHG，高级别肿瘤合并低级别成分），132名患者为单纯高级别肿瘤（pure high grade，pHG），中位随访时间为 39.32 （26.82,61.37）个月，两组患者间的基线特征分布平衡。 pHG 组的 5 年无复发生存率（recurrence-free survival rate，RFSR）显著低于mHG 组（50.5% vs. 80.0%, P=0.01）。多变量 Cox 回归分析显示，合并低级别成分是复发的独立保护因素（HR= 0.42,P=0.02），其他影响因素包括 T1 分期（HR=2.09,P=0.01）。结论：合并低级别成分是高级别单发原发性NMIBC 患者的独立预后保护因素。

Abstract

Objective：To evaluate the impact of coexisted low-grade components on the prognosis of patients with high-grade solitary primary non-muscle invasive bladder cancer（NMIBC）. Methods：A retrospective analysis was conducted on patients diagnosed with primary，solitary，high-grade non-muscle invasive bladder cancer（NMIBC）who underwent transurethral resection of bladder tumor（TURBT）at Peking University People＇s Hospital between January 2015 and December 2019.All patients received single-dose intravesical chemotherapy within 24 hours after TURBT.Only patients accetpting adequate adjuvant intravesical chemotherapy were included for further analysis.Adequate intravesical chemothera- py was defined as weekly instillation for 8 weeks and monthly instillation for at least 6 months.All pa- tients were strictly followed up according to the preestablished schedule with cystoscopic surveillance.The primary endpoint was recurrence free survival.Kaplan-Meier curve was used to compare the recurrence free survival of mHG group and pHG group.Univariable and multivariable Cox regression was conducted to evaluate the risk factors for tumor recurrence.Patients with variant histology，concurrent upper tract urothelial carcinoma，and incomplete resection which required re-TURBT were excluded.Patients without single instillation postoperative were also eliminated from the final cohort. Results：A total of 167 patients were enrolled in the final cohort，with 35 patients having mixed high-grade tumors（mHG）and 132 pa- tients having pure high-grade tumors（pHG）.The median follow-up time was 39.32 （26.82，61.37） months.Baseline characteristics were well balanced between the two groups with regard to age，gender， pathological characteristics and instillation doses.Compared with the mHG group，the 5-year recurrence- free survival rate（RFS）of the pHG group was significantly lower（80.0％vs.50.5％，P=0.01）. Multivariate Cox regression analysis further confirmed that the presence of mixed low-grade components was an independent protective factor for recurrence free survival（HR=0.42,P=0.02），and other risk factors included T1 stage (HR=2.09,P=0.01).while tumor size was not associated with recurrence free survival. Conclusion：Coexistence of low-grade component in pathological specimen was associated with lower recurrence rate in patients with primary，solitary high-grade non-muscle invasive bladder cancer.Thus，it should be considered as a favorable pathological feature in bladder cancer patients.

关键词

非肌层浸润性膀胱癌 / 高级别 / 合并 / 低级别 / 预后

Key words

Non-muscle invasive bladder cancer（NMIBC） / High-grade / Coexistence / Low-grade / Prognosis

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