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目的:探讨非肌层浸润性膀胱癌(non-muscle-invasive bladder cancer,NMIBC)伴术前脓尿患者的临床特点及脓尿对其预后方面的临床意义。方法:回顾性分析2009年11月~2011年3月我院278例首发非肌层浸润性膀胱癌患者的临床病理资料。定义脓尿为每高倍视野下尿白细胞数量≥5个,根据术前尿白细胞值,将患者分为脓尿-组(尿白细胞<5)和脓尿+组(尿白细胞≥5),运用卡方检验分析脓尿和各临床病理特点之间的关系,运用Kaplan-Meier法比较两组之间无复发生存期(recurrence-free survival,RFS)和无进展生存期(progression-free survival,PFS)的区别,并用Log-rank检验评估其统计学意义。结果:278例NMIBC患者中,有98例(35.3%)出现术前脓尿,平均随访48.6(3~72)个月。在随访期间内,脓尿的出现与大体积、多发、高TNM分期、高级别肿瘤以及高复发率和高进展率显著相关,且经Kaplan-Meier法分析发现,脓尿+组患者无复发生存率明显低于脓尿-组患者(58.2%vs.71.7%,P=0.016);同样,脓尿+组患者无进展生存率也明显低于脓尿-组患者(74.5%vs.85.6%,P=0.018)。结论:非肌层浸润性膀胱癌伴术前脓尿患者肿瘤多发且体积大,组织学分级和临床分期高,预后较差,应积极手术治疗并术后密切随访。
Objective: To investigate the clinical characteristics of non-muscle-invasive bladder cancer (NMIBC) with preoperative pyuria and the clinical significance of pyuria on its prognosis. Methods: The clinical and pathological data of 278 patients with non-muscle invasive bladder cancer from November 2009 to March 2011 in our hospital were retrospectively analyzed. According to the preoperative urinary white blood cell count, the patients were divided into pyuria-group (urinary white blood cells <5) and pyuria + group (urinary white blood cells≥5). Using chi-square test The relationship between pyuria and each clinicopathological features was analyzed by using Kaplan-Meier method to compare the difference between the two groups in recurrence-free survival (RFS) and progression-free survival (PFS) Log-rank test to assess the statistical significance. Results: Among 278 patients with NMIBC, 98 cases (35.3%) had preoperative pyuria, with an average follow-up of 48.6 (3-72) months. In the follow-up period, the appearance of pyuria was associated with bulky, multiple, high TNM staging, high-grade tumors and high recurrence rate and high progression rate. Kaplan-Meier analysis showed that the recurrence-free survival rate was significantly higher in patients with pyuria + Similarly, patients with pyuria + had significantly lower progression-free survival than those with pyuria - patients (74.5% vs 85.6%, P = 0.018) (58.2% vs 71.7%, P = 0.016). Conclusion: Non-muscle invasive bladder cancer with preoperative pyuria patients with multiple tumors and large volume, high histological grade and clinical stage, the prognosis is poor, should be actively treated and follow-up after surgery.