T1G3膀胱移行细胞癌复发特点分析

目的分析T1G3膀胱移行细胞癌的复发特点.方法自北京协和医院1993至2003年的复发性膀胱移行细胞癌病例中,选择首次治疗方法相同的T1期病例72例,按病理分级分组,G3组37例,G1-2组35例.分别对首次复发时间,复发次数,复发肿瘤的数量、形态、病理分期以及复发后治疗方法等资料进行统计分析.结果T1G3组第1、2、3年及4年以上的复发率分别为29.7%、40.5%、18.9%及10.8%,T1G1-2组分别为14.3%、34.3%、31.4%及20.0%,两组比较差异有统计学意义（P=0.025）.T1G3组单次复发的4例（10.8%）,3次以上复发的20例（54.0%）,T1G1-2组分别为17例（48.6%）和6例（17.2%）,两组比较差异有统计学意义（P＜0.01）.T1G3组复发后肿瘤病理分期T2期以上的32例（86.5%）,T1G1-2组15例（42.8%）.T1G3组最后一次复发后进行膀胱部分切除或膀胱全切治疗的35例（94.6%）,T1G1-2组20例（57.1%）,两组比较差异有统计学意义（P＜0.01）.结论T1G3膀胱移行细胞癌治疗后近期易复发,且复发次数多,复发后多数发展为浸润癌,应当引起临床治疗上的重视,注意术后随访.

Characteristics of recurrence of T1G3 transitional cell carcinoma of bladder

OBJECTIVE: To investigate the characteristics of recurrence of T1G3 transitional cell carcinoma (TCC) of bladder. METHODS: The clinical data of 72 patients with TCC of bladder of the stage T1, 37 being of the stage T1G3 and 35 being of the stage T1G1-2, who underwent the initial treatment by transurethral resection of bladder tumor plus post-operative bladder infusion were analyzed. RESULTS: The first, second, third, and fourth year recurrent rates of the T1G3 group were 29.7%, 40.5%, 18.9%, and 10.8% respectively, all significantly higher than those of the T1G2 group (14.3%, 34.3%, 31.4%, and 20.0% respectively, t = 1.994, P = 0.025). The rate of recurrence for only time was 10.8% in the T1G3 group (4/37), significantly lower than that of the T1G1-2 group (17/35, 48.6%, P < 0.01). The rate of recurrence for more than 3 times was 54.0% in the T1G3 group (20/37), significantly higher than that of the T1G1-2 group (6/35, 17.2%, P < 0.01). The rate of recurrent tumor at the pathological stage over T2 was 86.5% (32/37) in the T1G3 group, higher than that of the T1G1-2 group (42.8%, 15/35). The rate of partial or total cystectomy at the last recurrence in the T1G3 group was 94.6% (35/37), significantly higher than that of the T1G1-2 group (57.1%, 20/35, chi(2) = 14.00, P < 0.05). CONCLUSION: A kind of dangerous bladder cancer, TCC at the stage T1G3 is apt recur soon after the treatment with a high recurrent frequency. Most recurrent tumors evolve into invasive cancer.