摘要
目的分析T1G3膀胱癌的临床特点及复发、进展、死亡的风险因素，提高对T1G3膀胱癌的认识和治疗效果。方法收集1998年1月至2006年10月天津市泌尿外科研究所诊断为T1G3膀胱癌且资料完整的患者187例。男162例，女25例。年龄35—92岁，平均66岁。进行临床流行病学调查并随访预后情况。寿命表法估计1、2、3、5年复发率、进展率及死亡率。将年龄、性别、出现症状至就诊时间、有无肾积水、手术方式、术后是否即刻灌药、膀胱灌注药物种类、肿瘤直径、肿瘤数量、肿瘤形态、有无原位癌、复发次数、初次复发时间≤6个月作为变量，分别进行肿瘤复发、疾病进展、死亡的Kaplan—meier单因素及Cox多因素生存分析。结果本组患者随访12～111个月，平均46个月。肿瘤复发100例（53．5％），进展61例（32．6％），死亡37例（19．8％）。1、2、3、5年肿瘤复发率分别为35．0％、60．0％、63．0％、65．0％，疾病进展率分别为12．0％、27．0％、34．0％、38．0％，死亡率分别为0、11．0％、17．0％、26．0％。肿瘤直径、肿瘤数量、即刻灌注、初次复发时间≤6个月是T1G3膀胱癌复发的危险因素；肿瘤形态、原位癌、初次复发时间≤6个月、复发次数是T1G3膀胱癌进展的危险因素。肿瘤进展是患者死亡的危险因素。结论肿瘤直径≥3cm、多发、初次复发时间≤6个月的T1G3膀胱癌患者更容易复发，应加强随访，即刻膀胱灌注可以降低T1G3膀胱肿瘤复发的风险。对肿瘤形态呈结节状、合并原位癌、初次复发时间≤6个月、多次复发等进展高危风险因素的T1G3膀胱肿瘤患者，应早期行膀胱切除。
Objective The clinical features of T1G3 bladder cancer and the risk factors of the recurrence, progression and death were studied. Methods One hundred and eighty-seven cases with T1G33 bladder cancer were diagnosed from 1998 to 2006 in the Institute of Urology of Tianjin. There were 162 males and 25 females in the study group. The average age was 66 years （35 -92 years）. A clinical epidemiology study was carried out and prognosis information was collected. The risk factors were preliminary screened with Kaplan-Meier univariate analysis and then finally determined with multivariate Cox proportional hazards regression model. Results Based on a mean follow-up of 46 months （range, 12 to 111 months）, 100 （53.5%） of the cases had a recurrence, 61 （32.6%） cases progressed and 37（ 19.8% ） cases died. The 1-, 2-, 3-, 5-year probability of tumor recurrence was 35.0% , 60.0% , 63.0% , 65.0%. The 1-, 2-, 3-, 5-year probability of disease progression was 12.0% , 27.0% , 34.0% , 38.0% and the 1-, 2-, 3-, 5-year probability of death was 0, 11.0% , 17.0% , 26. 0% , respectively. The tumor size, number of tumors, immediately intravesical instillation and the first recurrence time ≤6 months were the risk factors associated with tumor recurrence of T1G3 bladder cancer. The tumor modality, cancer in situ, the first recurrence time ≤6 months and frequency of recurrence were the risk factors of disease progression. Only progression was a risk factor of death. Conclusions Tumor of TIG3 bladder cancer patients with features such as the tumor size ≥3 cm, tumor multiplicity, and first recurrence time ≤6 months were more likely torelapse. Immediately intravesical instillation could reduce the risk of recurrence. Cystectomy must be carried out early if the patient with T1G3 bladder cancer has the risk factors of progression such as the nodous tumor, tumor in suit, the first recurrence time ≤6 months and frequency of recurrence 〉 1.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2011年第11期766-770,共5页
Chinese Journal of Urology
关键词
膀胱肿瘤
癌
T1G3
预后
生存分析
Urinary bladder neoplasms
Carcinoma
TIG3
Prognosis
Survival analysis
