CAJ | 학술논문

目的：总结高危非肌层浸润性膀胱癌的患者特点及治疗经验。方法回顾性分析1999年5月至2009年12月间中山大学肿瘤医院收治的185例高危非肌层浸润性膀胱癌。采用 Kap-lan-Meier 法以及 Cox 风险预测模型分析其肿瘤复发率、进展率、保留有功能膀胱生存率、高危非肌层浸润性膀胱癌的复发、进展的危险因素。结果经过6～120个月的随访（中位随访时间61个月），失访10例，175例有完整数据，其中153例行保留膀胱治疗，另有22例早期行根治性全膀胱切除术。153例保留膀胱的非肌层浸润性膀胱癌1年和5年无肿瘤复发生存率分别为77．9％和58．6％；1年和5年无肿瘤进展生存率分别为93．9％和81．0％。在随访期内保留有功能膀胱生存率为81．7％。多因素分析发现，肿瘤数量、分级、分期是膀胱肿瘤复发的影响因素（P 均＜0．05）；而肿瘤分期是膀胱肿瘤进展的唯一影响因素（P ＜0．01）。结论高危非肌层浸润性膀胱癌术后复发及进展率高，尤其是多发、高级别及 T1期肿瘤。
목적：총결고위비기층침윤성방광암적환자특점급치료경험。방법회고성분석1999년5월지2009년12월간중산대학종류의원수치적185례고위비기층침윤성방광암。채용 Kap-lan-Meier 법이급 Cox 풍험예측모형분석기종류복발솔、진전솔、보류유공능방광생존솔、고위비기층침윤성방광암적복발、진전적위험인소。결과경과6～120개월적수방（중위수방시간61개월），실방10례，175례유완정수거，기중153례행보류방광치료，령유22례조기행근치성전방광절제술。153례보류방광적비기층침윤성방광암1년화5년무종류복발생존솔분별위77．9％화58．6％；1년화5년무종류진전생존솔분별위93．9％화81．0％。재수방기내보류유공능방광생존솔위81．7％。다인소분석발현，종류수량、분급、분기시방광종류복발적영향인소（P 균＜0．05）；이종류분기시방광종류진전적유일영향인소（P ＜0．01）。결론고위비기층침윤성방광암술후복발급진전솔고，우기시다발、고급별급 T1기종류。
Objective To summarize the clinical characteristics and treatment outcomes of patients with high-risk non-muscle invasive bladder cancer.Methods A total of 1 85 patients diagnosed with high-risk invasive bladder cancer admitted to Sun Yat-sen University Cancer Center from May 1 999 to December 2009 were included in this study.Tumor recurrence rate,progression-free rate and survival rate of patients with func-tional bladder preservation were assessed by Kaplan-Meier plot.Independent risk factors of the recurrence and progression of high-risk non-muscle invasive bladder cancer were evaluated by Cox regression analysis.Results The patients were followed up for 6 ~1 20 months with a median of 61 months.Ten patients were censored for loss of follow-up.In total,1 75 patients had complete clinical data,1 53 of whom undergoing bladder preserva-tion treatment and 22 receiving early radical cystectomy.The 1 -and 5-year tumor recurrence-free survival rates were 77.9%,58.6% and 1 -and 5-year tumor progression-free survival rates were 93.9%,81 .0% for 1 53 pa-tients undergoing bladder preservation treatment.During subsequent follow-up,81 .7% of patients were still a-live with a functional bladder.Multivariate analysis revealed that number of tumors,tumor grade and tumor stage were independent predictors for tumor recurrence (all P <0.05),but tumor stage was the only independ-ent predictor for tumor progression (P <0.01 ).Conclusion Postoperative recurrence and progression rates of high-risk non-muscle bladder cancer are high,especially for patients with high tumor grade,T1 stage and mul-tiple onsets.