多点活组织检查在非肌层浸润性膀胱癌诊治中的临床价值

摘要

Objective To evaluate the clinical value of multiple bladder biopsies in the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC) during transurethral resection of bladder tumor(TURBT).Methods The data of 408 NMIBC patients from January 2009 to December 2013 was analyzed retrospectively.There were 302 males and 106 females.The mean age of these 408 patients was 65 years old from 33 to 86 years.Bladder multipoint biopsies were performed in 216 patients (biopsy group),and were not performed in the other 192 patients (control group).The multipoint biopsies were taken from right and left bladder walls,anterior and posterior walls,dome,trigone,prostatic urethra and abnormal mucosa.There were 127 males and 89 females in the biopsy group,with a mean age of 64 years old (from 18 to 87 years).In the control group,118 males and 74 females aged between 15 and 92 years have an average age of 66 years old.There was no statistically significant difference in regard to gender and age between the two groups.The positive rate of biopsy and whether the diagnosis and treatment plan changed in the study group were recorded and the recurrence and progression rates were compared between study and control groups.Results Of these 216 multiple mucosa biopsies,the total abnormal detection rate was 48.1％ (104/216).There were urothelial carcinoma in 12.5％ (39/216),carcinoma in situ in 5.6％ (12/216),dysplasia in 9.7％ (21/216),cystitis in 20.4％.The final diagnosis were changed in fifteen patients (6.9％) due to the biopsy results,and 38 patients(17.6％) treatment plans were changed.The 1-,3-,and 5-year recurrence-free survival rates (RFS) of biopsy group and control groups were 96.3％ vs.85.4％(x2 =14.955,P=0.000),85.2％ vs.69.8％ (x2 =13.183,P =0.000) and 69.9％ vs.64.1％ (x2 =1.574,P =0.245);progression-free survival(PFS) were 99.1％ vs.96.3％ (x2 =8.253,P =0.006),94.0％ vs.87.0％ (x2 =5.901,P=0.017) and90.3％ vs.85.4％ (x2 =2.273,P=0.169).The 1-and 3-year RFS and PFS of biopsy group were higher than control group.There was no significant difference in the 5-year RFS and PFS between the two groups.Conclusions Multiple bladder biopsies could be helpful for pathological diagnosis and the post-TUR treatment of NMIBC.Furthermore,it may reduce the early recurrence and progression rates of NMIBC,but have no effect on long-term prognosis.%目的 探讨经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)中多点活组织检查在非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC)诊断和治疗中的临床价值.方法 回顾性分析2009年1月至2013年12月收治的408例NMIBC患者的临床资料.男302例,女106例;年龄33 ～ 86岁,平均65岁.其中216例行TURBT+膀胱多点活检术(活检组),活组织检查处包括膀胱左侧壁、右侧壁、前壁、后壁、顶部、三角区、前列腺尿道及异常黏膜;192例仅行TURBT(对照组).活检组男127例,女89例;年龄18 ～ 87岁,平均64岁.对照组男118例,女74例;年龄15 ～ 92岁,平均66岁.两组患者性别、年龄差异均无统计学意义.观察活检组患者多点活检阳性检出率、诊断和治疗方案有无变化,以及两组患者肿瘤复发和进展情况.结果 活检组216例患者总体异常检出率为48.1％ (104/216),其中尿路上皮癌27例(12.5％),原位癌12例(5.6％),非典型增生21例(9.7％),炎症44例(20.4％).15例(6.9％)患者因活检结果改变最终诊断,38例(17.6％)患者更改治疗方案.活检组和对照组患者1、3、5年无复发生存率(recurrence-free survival,RFS)分别为96.3％与85.4％(x2=14.955,P＜0.001)、85.2％与69.8％ (x2=13.183,P＜0.001)、69.9％与64.1％(x2=1.574,P=0.245),无进展生存率(progression-free survival,PFS)分别为99.1％与96.3％(x2=8.253,P=0.006)、94.0％与87.0％(x2=5.901,P=0.017)、90.3％与85.4％(x2=2.273,P=0.169).活检组患者1、3年RFS及PFS明显高于对照组,而两组间5年RFS及PFS比较差异无统计学意义.结论 TURBT术中多点活组织检查可提高NMIBC患者的病理诊断准确性,指导术后治疗方案的选择,降低早期肿瘤复发及进展率,但对于远期预后没有影响.