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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。
Objective To analyze the recurrence characteristics of T1G3 bladder transitional cell carcinoma. Methods From 1993 to 2003, Peking Union Medical College Hospital patients with recurrent bladder transitional cell carcinoma, the first choice of the same treatment for T1 cases of 72 cases, according to pathological grading, 37 cases of G3, G1-2 group of 35 cases. Respectively, the first recurrence time, the number of recurrence, the number of recurrent tumors, morphology, pathological staging and post-relapse treatment methods and other data were statistically analyzed. Results The recurrence rates of T1G3 group were 29.7%, 40.5%, 18.9% and 10.8% at 1, 2, 3 and 4 years respectively. The T1G1-2 group was 14.3% 34.3%, 31.4% and 20.0% respectively. There was significant difference between the two groups (P = 0 · 025). Four patients (10.8%) had a single recurrence in T1G3 group, 20 cases (54.0%) had more than three recurrences, 17 (48.6%) cases in T1G1-2 group and 6 cases (17.2% %), The difference between the two groups was statistically significant (P <0.01). Thirty-two cases (86.5%) had tumor stage T2 after tumor recurrence in T1G3 group and 15 cases (42.8%) in T1G1-2 group. Twenty-five patients (94.6%) underwent partial or total curative resection of the bladder in T1G3 group and 20 (57.1%) patients in T1G1-2 group, the difference was statistically significant (P <0 · 01). Conclusion T1G3 bladder transitional cell carcinoma is easy to relapse and has many recurrences after its treatment. Most patients with invasive carcinoma of the bladder after recurrence should pay attention to the clinical treatment, pay attention to follow-up after operation.