经尿道膀胱肿瘤电切除术中留取切缘标本对非肌层浸润性膀胱癌的诊疗意义

摘要

目的 探讨经尿道膀胱肿瘤电切除(TURBT)术中留取切缘标本对非肌层浸润性膀胱癌诊断及治疗的意义.方法 回顾性分析2009年6月至2014年1月天津医科大学第二医院泌尿外科收治的356例非肌层浸润性膀胱癌手术患者资料.其中TURBT术中留取切缘标本176例(切缘组),切缘标本包括膀胱肿瘤基底及边缘组织.180例仅行TURBT(常规组).观察切缘组患者切缘阳性率,诊断及治疗方案有无变化.采用x2检验对两组患者肿瘤复发率和进展率进行比较分析,使用Mann-WhitneyU检验比较其中位无复发生存时间.结果 176例TURBT术中留取切缘标本患者切缘阳性率为19.3％ (34/176),其中肿瘤基底阳性率为11.9％ (21/176),肿瘤边缘阳性率为7.4％(13/176).切缘标本为Ta期者占1.7％(3/176),T1期5.7％ (10/176),T2期8.0％ (14/176),Tis期4.0％ (7/176).176例患者中10.8％ (19/176)的患者因切缘标本结果改变最终诊断,18.2％(32/176)的患者更改术后治疗方案.356例患者平均随访36.8个月,切缘组和常规组两组患者肿瘤复发率分别为22.2％ (39/176)和35.6％(64/180),中位无复发生存时间为33.0和23.5个月,肿瘤进展率为5.7％(10/176)和10.6％(19/180);两组间肿瘤复发率(x2=7.677,P=0.007)及无复发生存时间(U=12 605,p=0.001)差异均有统计学意义;肿瘤进展率比较差异无统计学意义(x2=2.825,P=0.121).结论 TURBT术中留取切缘标本可提高病理诊断准确性,指导术后治疗方案的选择.%Objective To evaluate the value of taking surgical margin specimens during transurethral resection of bladder tumor (TURBT) in the diagnosis and treatment of non-muscle invasive bladder cancer.Methods The data of 356 patients with non-muscle invasive bladder cancer from June 2009 to January 2014 were analyzed retrospectively.A standardized protocol were performed during TURBT in 176 patients(surgical margin group),by taking surgical margin specimens from tumor base and 'normal'-appearing margin sites.The other 180 cases merely received general TURBT (general group).To observe the positive rate of surgical margin specimens and whether the diagnosis and treatment plan changed in the surgical margin group.Using Chi-square test to compare the recurrence and progression rates between surgical margin and general groups.To compare their recurrence-free survival time by Mann-Whitney U test.Results Of these 176 surgical margin specimens,the positive rate was 19.3％ (34/176),which consists of tumor base 11.9％ (21/176) and tumor normal-appearing margin 7.4％ (13/176).Following with urothelial carcinoma Ta stage in 1.7％ (3/176),T1 stage in 5.7％ (10/176),T2 stage in 8.0％ (14/176),carcinoma in situ (Tis) in 4.0％ (7/176).Among these 176 patients final diagnosis were changed in 10.8％ (19/176)patients due to the specimens results,and 18.2％ (32/176)patients altered their treatment plans.All 356 patients with a mean follow-up of 36.8 months (6 to 60 months).Two groups of patients(surgical margin group vs.general group) recurrence rates respectively were 22.2％ (39/176) vs.35.6％ (64/180),recurrence-free survival time were 33.0 months vs.23.5 months and progression rates were 5.7％ (10/176) vs.10.6％ (19/180).Compared with general group,patients who were taken additional surgical margin specimens showed significantly lower recurrence rate (x2 =7.677,P =0.007) and longer recurrence-free survival time (U =12 605,P =0.001).While the progression rate showed no statistical difference between them (x2 =2.825,P =0.121).Conclusion Taking additional surgical margin specimens during transurethral resection of bladder tumor is helpful for pathological diagnosis and the planning of further treatment.