本文關鍵詞： 膀胱癌 二次經(jīng)尿道電切 預后 免疫組化 腫瘤標志物 評分模型　出處：《中南大學》2014年博士論文　論文類型：學位論文

【摘要】：目的：非肌層浸潤型膀胱癌(NMIBC)常規(guī)手術治療后復發(fā)、進展率高。第二次經(jīng)尿道膀胱腫瘤電切運用于臨床后,NMIBC預后得到改善。但在國內(nèi),尚缺乏足夠的相關臨床資料。本研究旨在探究我院reTUR治療情況以及其對患者術后預后的影響。 方法：回顧性收集2008年至2013年滿足納入指征的NMIBC患者資料,利用K-M生存曲線、多因素COX比例風險模型分析reTUR對患者預后的影響。 結(jié)果：共計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)。術后2年時,54%單次TUR組患者膀胱癌復發(fā),而接受ReRUR者36%膀胱癌復發(fā)(p0.05)。術后2年時,25%單次TUR組患者膀胱癌進展,而接受ReRUR者僅11%膀胱癌進展(p=0.157)。多因素分析中,reTUR為無復發(fā)生存率的獨立預測因子(HR=0.35,95%CI=0.17-0.71p=0.003), reTUR對無進展生存率無統(tǒng)計學意義(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后復發(fā)。盡管無統(tǒng)計學意義,reTUR可能影響術后疾病進展,其確切影響仍有待于進一步研究。 目的：NMIBC是一類異質(zhì)性很高的腫瘤。盡管reTUR可明顯改善膀胱癌患者預后,但并非滿足reTUR適應癥的所有膀胱癌患者都有殘余腫瘤,都從reTUR中受益。因此,我們設計這一章節(jié)試圖探究其他臨床和分子指標是否對reTUR有指導作用。 方法：回顧性收集2008年至2013年接受reTUR的NMIBC患者資料,并對所有患者第一次電切的腫瘤標本行免疫組織化學測定P53、Ki67、VEGF、E-cadheri、n survivin表達。利用多因素logistic分析建立殘余腫瘤的風險方程。根據(jù)風險方程回歸系數(shù)建立殘余腫瘤風險評分模型。 結(jié)果：殘余腫瘤的風險模型為：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險模型,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-中高危分類的敏感度、特異度(93.8%、50%)優(yōu)于單獨按腫瘤大小(50%、90%)、p53(50%、75%)、E-cadherin分類(62.5、75%)。 結(jié)論：腫瘤大小、p53、E-cadherin為膀胱腫瘤電切術后腫瘤殘余風險的獨立危險因素。通過風險評分建�？梢詫⒒颊叻譃榈臀＝M、中危組、高危組,更好地劃分了患者術后腫瘤殘余的風險,且采用風險模型明顯優(yōu)于單獨采用單個因素評價殘余腫瘤風險。對于高危人群,強烈建議reTUR,對于低危人群,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.
【學位授予單位】：中南大學
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R737.14

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