EORTC评分系统在非肌层浸润性膀胱癌预后预测中的临床应用

摘要

Background and purpose: Bladder cancer is the most common tumor in China, and 80% is non-muscle invasive. After 5-15 years, the recurrence rate is 60%-85%, of which 20% would progress to muscle invasive. This study was aimed to assess the feasibility and accuracy of applying the scoring system proposed by EORTC in predicting recurrence and progression of non-muscle-invasive bladder cancer after transurethral resection. Methods: 213 non-muscle-invasive bladder cancer (NMIBC) patients were treated from our hospital from Jan. 2003 to Dec. 2005. Using EORTC predicting system, we calculated the 1-year and 5-year recurrence and progression of bladder cancer after TUR-BT in each grade, and compared those with the actual probabilities. Results: The patients were 153(71.8%) male and 60 (28.2%) female with an age range of 41 to 88 years. 96 (45.1%) patients had a recurrent disease, 90 (42.3%) had a tumor larger than 3 cm in diameter, 97 (45.5%) had multiple lesions, 6 (2.8%) had carcinoma in situ, 86 (40.4%) had stage T, lesions, and 18 (8.4%) had a high-grade disease. After 1 year, there were 65(30.5%) patients with recurrence and 10 (4.7%) with progression. After 5 years, there were 110 (51.6%) patients at least with one recurrence and 30 (14.1%)with progression. Conclusion: EORTC scoring system can be used for the patients in our hospital for predicting risk factors of recurrence and progression of non-muscle-invasive bladder cancer after transurethral resection. Whether the system is suitable for Chinese patient still need further study.%背景与目的:膀胱癌是我国泌尿系统最常见的肿瘤,其中80％为非肌层浸润性,5～15年内的复发率高达60％～85％,其中20％可进展为浸润性肿瘤.本研究探讨欧洲癌症研究与治疗组织(EORTC)建议的非肌层浸润性膀胱癌患者术后复发和进展评分系统用于我国非肌层浸润性膀胱癌患者预后评估的可行性和准确性.方法:选取2003年1月-2005年12月在我科行TUR-BT的213例非肌层浸润性膀胱癌患者.根据EORTC评分系统的影响因素对每位患者的预后风险进行评分,计算各评分等级中每位患者的1年及5年复发率和进展率,并与实际的1年及5年复发率和进展率进行比较.结果:213例患者中,男性153例(71.8％),女性60例(28.2％),年龄41～88岁(平均57岁).其中96例(45.1％)为复发患者,90例(42.3％)的肿瘤最大直径≥3 cm,97例(45.5％)为多灶性肿瘤,6例(2.8％)伴有原位癌,86例(40.4％)属于T1期,18例(8.4％)为尿路上皮癌3级.1年后,有65例(30.5％)患者发生肿瘤复发,10例(4.7％)患者肿瘤进展为T2期；5年后,有110例(51.6％)患者发生至少1次复发,30例(14.1％)患者进展为T2期及以上.结论:EORTC建议的评分系统可用来预测本院非肌层浸润性膀胱癌患者TUR-BT术后的肿瘤复发和进展风险.但是否适用于国内人群还有待于进一步验证.