EORTC危险评分系统对T1期非肌层浸润性膀胱癌患者的预后评价

摘要

目的：评价欧洲癌症研究与治疗组织（EORTC）膀胱癌预后风险评分表对T1期非肌层浸润性膀胱癌（non-muscle-invasive bladder cancer，NMIBC）患者预后判断的准确性。分析T1期NMIBC复发进展相关因素，探讨更适用于T1期NMIBC的危险分层方法。方法：回顾性分析2011年1月至2013年6月天津医科大学肿瘤医院108例行经尿道膀胱肿物电切术的T1期NMIBC患者的临床病理资料。根据患者不良预后指标进行评分，应用ROC曲线获取临界值重新进行危险分层，建立新的危险评分模型。结果：108例患者中男性90例（83%）、女性18例（17%），中位年龄65（24~88）岁，21例（19.4%）复发，11例（10.2%）进展。结论：EORTC评分系统对T1期NMIBC患者复发进展预测效能不准确。肿瘤大小及既往复发概率为肿瘤复发的独立性预后因素，肿瘤分级及既往复发概率为肿瘤进展的独立性预后因素。应用新的危险评分模型能够更准确的预测T1期NMIBC患者的复发进展风险。%Objective:To assess the accuracy of the European Organization of Research and Treatment of Cancer (EORTC) Risk Tables in predicting the prognosis of patients with T1 non-muscle-invasive bladder cancer (NMIBC) treated in the Tianjin Medical University Can-cer Institute and Hospital (TMUCIH). The prognostic factors of T1 NMIBC are also explored, and a new risk scoring model suitable for T1 NMIBC is determined. Methods:We retrospectively reviewed the clinicopathologic characteristics of 108 patients with T1 NMIBC who underwent transurethral resections in TMUCIH from January 2011 to June 2013. We scored patients based on the number of ad-verse factors. Afterwards, divided them into different risk groups by the limits determined using receiver operating characteristic curve (ROC) analysis, and created a new risk scoring model. Results:In a group of 108 patients, 90 (83%) were male and 18 were female (17%). The median age was 65 years old (ranging from 24 to 88). Furthermore, 21 patients (19.4%) had a recurrence and 11 cases (10.2%) progressed to muscle-invasive disease. Conclusion:The EORTC cannot accurately predict the recurrence and progressive rate of T1 NMIBC. The most important prognostic factors for recurrence were tumor size and prior recurrence rate. Tumor grade and prior recurrence rate are independent prognostic factors for tumor progression. The new risk scoring model is more accurate in predicting the recurrence risk and progression of T1 NMIBC.