欧洲癌症研究与治疗组织风险评分表对国人非肌层浸润性膀胱癌预后判断的意义

摘要

目的 验证欧洲癌症研究与治疗组织(European Organization for Research and Treatment of Cancer,EORTC)膀胱癌预后风险评分表对我国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.方法 按照EORTC评分标准对225例NMIBC患者进行评分并按得分高低分组,寿命表法计算每组患者的1年和5年实际复发率及进展率,Log-Rank检验行组间比较并与EORTC评分表相应结果对比.多因素分析筛选影响NMIBC预后的独立因素.结果 低、中、高复发风险者分别32、109、84例,低、中、高进展风险者分别25、128、72例.低、中、高复发及进展风险组术后1年复发率和进展率分别为15.1%、31.2%、55.5%和0.3%、2.0%、15.5%;术后5年复发率和进展率分别为28.2%、55.2%、75.0%和1.4%、12.9%、54.7%.除高进展风险组5年进展率略高外,其余均接近EORTC评分表.各组间相比,复发率及进展率的差异有统计学意义(P＜0.01).多因素分析表明,EORTC评分为影响NMIBC患者术后复发及进展风险的独立因素(P＜0.01).结论 EORTC风险评估表使用简便,可以按照复发及进展风险概率将患者准确分层,值得推广应用.%Objective To Validate the prognostic significance of the European Organization for Research and Treatment of Cancer (EORTC) risk tables in Chinese patients with non-muscle invasive bladder cancer (NMIBC). Methods According to the scoring standard of the EORTC system, 225 NMIBC patients were reviewed and divided into 3 groups: low, intermediate and high risk groups for recurrence and progression respectively. The probabilities of recurrence and progression at 1 year and 5 year for each group were calculated using life-table analysis and then compared with the EORTC risk tables. Log-Rank test and multivariable analysis were used to analyze the possible differences between risk groups and to find independent prognostic factors. Results For low (n= 32, 25), intermediate (n=109, 128) and high (n=84, 72) risk groups, the probabilities of recurrence and progression at 1 year were 15. 1%, 31.2%, 55.5% and 0. 3%, 2. 0%, 15.5% respectively. The probabilities at 5 year were 28. 2%, 55.2%, 75.0% and 1.4%, 12.9%, 54. 7%. All the results were similar to that of EORTC tables except the probability of progression at 5 year for the high progression risk group.The differences between different risk groups were significant (P＜0.01). In a multivariable analysis for recurrence and progression, the EORTC scores had independent significance (P＜0.01). Conclusions EORTC risk tables could stratify NMIBC patients effectively according to the risk of recurrence and progression. It could be a useful tool for Chinese urologists.