本文關(guān)鍵詞： 膀胱癌 二次經(jīng)尿道電切 預(yù)后 免疫組化 腫瘤標(biāo)志物 評(píng)分模型　出處：《中南大學(xué)》2014年博士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：非肌層浸潤(rùn)型膀胱癌(NMIBC)常規(guī)手術(shù)治療后復(fù)發(fā)、進(jìn)展率高。第二次經(jīng)尿道膀胱腫瘤電切運(yùn)用于臨床后,NMIBC預(yù)后得到改善。但在國(guó)內(nèi),尚缺乏足夠的相關(guān)臨床資料。本研究旨在探究我院reTUR治療情況以及其對(duì)患者術(shù)后預(yù)后的影響。 方法：回顧性收集2008年至2013年滿(mǎn)足納入指征的NMIBC患者資料,利用K-M生存曲線(xiàn)、多因素COX比例風(fēng)險(xiǎn)模型分析reTUR對(duì)患者預(yù)后的影響。 結(jié)果：共計(jì)81位接受單次電切,36位接受reTUR的患者被納入研究。reTUR組中,殘余腫瘤率為44.4%(16/36)。術(shù)后2年時(shí),54%單次TUR組患者膀胱癌復(fù)發(fā),而接受ReRUR者36%膀胱癌復(fù)發(fā)(p0.05)。術(shù)后2年時(shí),25%單次TUR組患者膀胱癌進(jìn)展,而接受ReRUR者僅11%膀胱癌進(jìn)展(p=0.157)。多因素分析中,reTUR為無(wú)復(fù)發(fā)生存率的獨(dú)立預(yù)測(cè)因子(HR=0.35,95%CI=0.17-0.71p=0.003), reTUR對(duì)無(wú)進(jìn)展生存率無(wú)統(tǒng)計(jì)學(xué)意義(HR=0.51,95%CI=0.17-1.51, p=0.22)。 結(jié)論：reTUR可減少膀胱癌患者術(shù)后復(fù)發(fā)。盡管無(wú)統(tǒng)計(jì)學(xué)意義,reTUR可能影響術(shù)后疾病進(jìn)展,其確切影響仍有待于進(jìn)一步研究。 目的：NMIBC是一類(lèi)異質(zhì)性很高的腫瘤。盡管reTUR可明顯改善膀胱癌患者預(yù)后,但并非滿(mǎn)足reTUR適應(yīng)癥的所有膀胱癌患者都有殘余腫瘤,都從reTUR中受益。因此,我們?cè)O(shè)計(jì)這一章節(jié)試圖探究其他臨床和分子指標(biāo)是否對(duì)reTUR有指導(dǎo)作用。 方法：回顧性收集2008年至2013年接受reTUR的NMIBC患者資料,并對(duì)所有患者第一次電切的腫瘤標(biāo)本行免疫組織化學(xué)測(cè)定P53、Ki67、VEGF、E-cadheri、n survivin表達(dá)。利用多因素logistic分析建立殘余腫瘤的風(fēng)險(xiǎn)方程。根據(jù)風(fēng)險(xiǎn)方程回歸系數(shù)建立殘余腫瘤風(fēng)險(xiǎn)評(píng)分模型。 結(jié)果：殘余腫瘤的風(fēng)險(xiǎn)模型為：logitP=-1.85+2.29X1+1.21X2+1.28X3(X1為腫瘤大小,X2為p53,X3為E-cadherin)。成功建立殘余腫瘤風(fēng)險(xiǎn)模型,低危組、中危組、高危組腫瘤殘余率分別為9.1%、27.3%、85.7%。低危-中高危分類(lèi)的敏感度、特異度(93.8%、50%)優(yōu)于單獨(dú)按腫瘤大小(50%、90%)、p53(50%、75%)、E-cadherin分類(lèi)(62.5、75%)。 結(jié)論：腫瘤大小、p53、E-cadherin為膀胱腫瘤電切術(shù)后腫瘤殘余風(fēng)險(xiǎn)的獨(dú)立危險(xiǎn)因素。通過(guò)風(fēng)險(xiǎn)評(píng)分建�？梢詫⒒颊叻譃榈臀＝M、中危組、高危組,更好地劃分了患者術(shù)后腫瘤殘余的風(fēng)險(xiǎn),且采用風(fēng)險(xiǎn)模型明顯優(yōu)于單獨(dú)采用單個(gè)因素評(píng)價(jià)殘余腫瘤風(fēng)險(xiǎn)。對(duì)于高危人群,強(qiáng)烈建議reTUR,對(duì)于低危人群,可酌情考慮是否需reTUR。
[Abstract]:Objective: to improve the prognosis of NMIBC after the second transurethral resection of bladder tumor, the recurrence rate of NMIBCwas high after conventional surgical treatment of NMIBC.However, the prognosis of NMIBC was improved after the second transurethral resection of bladder tumor. The purpose of this study was to investigate the effect of reTUR treatment on postoperative prognosis in our hospital. Methods: from 2008 to 2013, the data of NMIBC patients who satisfied with the indications were collected retrospectively. K-M survival curve and multivariate COX proportional risk model were used to analyze the influence of reTUR on the prognosis of the patients. Results: a total of 81 patients underwent single electrosurgical resection and 36 patients with reTUR were included in the study. The residual tumor rate was 44.440% 16 / 36% in the TUR group and 54% of the patients in the single TUR group recurred at 2 years after operation. The recurrence rate of bladder cancer in 36% patients with ReRUR was p0.05. The progression of bladder cancer was observed in 25% of patients with single TUR 2 years after operation. In multivariate analysis, ReRUR was an independent predictor of recurrence free survival. ReTUR was 0.17-0.71p0.003. There was no significant difference between reTUR and progression survival rate (CI: 0.17-1.51, p0.22). Conclusion the recurrence of bladder cancer can be reduced by 1: reTUR, although no statistical significance may affect the progression of the disease, the exact effect remains to be further studied. [WT5 "HZ] [WT5" BZ] [WT5 "BZ] [WT5" BZ]. Objective: NMIBC is a class of highly heterogeneous tumors. Although reTUR can significantly improve the prognosis of bladder cancer patients, not all bladder cancer patients who meet the reTUR indication have residual tumors and benefit from reTUR. We designed this chapter to explore whether other clinical and molecular indicators can guide reTUR. Methods: the data of NMIBC patients receiving reTUR from 2008 to 2013 were collected retrospectively. The expression of P53 / Ki67 VEGF- E-cadherion survivin was determined by immunohistochemistry. The risk equation of residual tumor was established by multivariate logistic analysis. The risk scoring model of residual tumor was established according to the regression coefficient of risk equation. Results: the risk model of residual tumor was: 1: logit Pn-1.85 2.29X1 1.21X2 1.28X3X1: tumor size: X2: p53X3 was E-cadherin.A risk model of residual tumor was successfully established. The residual rate of tumor in low risk group, middle risk group and high risk group was 9.127.35.7.The sensitivity of low risk to middle high risk classification was 9.127.35.7. The specificity is better than that according to the size of the tumor alone. Conclusion: p53 E-cadherin is an independent risk factor of residual tumor risk after electroresection of bladder tumor. Patients can be divided into low risk group, middle risk group and high risk group by risk score modeling. The risk model is superior to single factor in evaluating residual tumor risk. ReTURs are strongly recommended for high risk population and reTURs should be considered as appropriate for low risk groups.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R737.14

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本文編號(hào)：1522021