RÉSUMÉ
【Objective】 To investigate the effects of preoperative lipid metabolism level on the postoperative prognosis of non-muscular invasive bladder cancer (NMIBC). 【Methods】 Clinical data of NMIBC patients who underwent surgical treatment in our hospital during Mar.2014 and May 2021 were retrospectively analyzed. Based on receiver operating characteristic (ROC) curve, the optimal cutoff values of all lipid metabolism indicators were determined and patients were classified accordingly. The independent risk factors for postoperative recurrence were identified with Cox regression model. The survival was analyzed with Kaplan-Meier, and recurrence-free survival (RFS) was compared using log-rank tests. A recurrence risk prediction model was established based on the high-density lipoprotein (HDL) and other clinic pathological factors and the accuracy of prediction was evaluated with the area under the ROC curve (AUC). 【Results】 Cox multivariate analysis showed HDL, tumor number, tumor size and histological grade were independent risk factors for recurrence (P<0.05). Kaplan-Meier analysis showed that RFS was significantly longer in the high-HDL group than in the low-HDL group (P<0.001). Incorporating HDL, tumor number, tumor size, histological grade, and tumor stage into the recurrence risk model, the AUC was 0.706, and internal cross validation showed the AUC was 0.711. 【Conclusion】 Preoperative HDL is an independent risk factor affecting the RFS of patients with NMIBC, and combining it with clinic pathological factors will improve the prediction of tumor recurrence.
RÉSUMÉ
Objective To evaluate the pathological stage,the presence of detrusor muscle and the clinical significance for standardized examination of specimens for en bloc transurethral resection technique with Hybrid Knife to treat NMIBC (ERBT) compared with conventional TURBT.Methods This was prospective randomized controlled study.This study was approved by the Ethics Committee of Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology (TJ-IRB20180604),and patients all signed informed consent.The clinical study registration number of this study:NCT03221062.The margin of the tumor was recognized and marked by with Hybrid Knife (0.5 cm away from the normal mucosa).Then water was injected into the submucosa and form a water pad,with a circular cutting layer by layer (0.5 cm away from the marked position),reaching the detrusor muscle in depth.After complete resection,the tumor was removed by specimen bag.Specimens for ERBT cohort were given standard handling.Resected specimen of ERBT stretched with pins on foam and its margin was stained.The basement of specimen was also stained.Total specimen sectioned into appropriate pieces for histological assessment in the department of pathology.TURBT cohort performed traditional surgical methods and pathological examination.All patients received postoperative intravesical instillation according to their pathology.Imaging and cystoscopy were performed every 3 months.The primary study end-point was the quality of resection,including the pathological stage and the presence of DM.Secondary outcomes were:short-term tumour recurrence rate (18 month),feasibility,and safety.Results From January 2017 to October 2017,109 patients were enrolled.51 patients underwent ERBT,and 58 patients underwent TURBT.The clinical characteristics of the patients in each cohort,such as average age,gender,average BMI,smoking history,the mean number of lesions and tumour size had no significant differences (P ＞ 0.05).The operation of 109 cases was completed successfully.There was no statistical difference between the operative time and the postoperative bladder irrigation time.Major intraoperative or postoperative complications (Clavien ≥ Ⅱ) did not occur in all of the patients.The percentage of T1 staging was higher in the ERBT cohort vs.TURBT cohort [21/51 (41.2％) vs.13/58 (22.4％),P =0.035],of which ERBT cohort accurately detected 9 cases (42.8％) of T1b patients,significantly higher than TURBT cohort (2 cases,15.4％) (P =0.096).All the ERBT samples showed the presence of DM (100.0％),while there was only 77.4％ in TURBT cohort (P ＜ 0.05).Mean follow-up (20.3 ± 3.1) months (ranged from 18 to 24 months).Recurrence rate were 8.9％ (4/45) in ERBT cohort vs.22.2％ (12/54) in TURBT cohort (P=0.059).Conclusions ERBT with Hybrid Knife for treatment NMIBC is a safe,effective,and provides high-quality specimens compared to TURBT.More high-risk NMIBC patients,especially T1 b patients,can be detected obviously by pathologist with the standardized treatment of specimens.
RÉSUMÉ
Objective To investigate curative efficacy of RevoLix 2 μm laser in combined with pirarubicine in the treatment of non-muscular invasive bladder cancer and its effects on level of serum vascular endothelial growth factor (VEGF).Methods 115 cases with non-muscular invasive bladder cancer who received therapy in our hospital from January 2012 to April 2013 were selected as research objects to retrospectively analyze their materials.According to therapeutic schemes,patients were divided into group A ( n=52 ) and group B ( n =63 ).Group A was given electrocision of bladder tumor and perfusion of pirarubicine 30 mg in 5% glucose injection 30 mL,one times per week,for eight weeks,and then one times per month,a total of one year; while group B was given RevoLix 2μm laser resection of bladder tumor and perfusion of pirarubicine 30 mg in 5% glucose injection 30 mL,one times per week, for eight week, and then one times per month, a total of one year.Then, operation status, incidence of complications after operation,level of VEGF and recurrence rate between the two groups were observed and compared.Results Compared with group A, group B had statistically less bleeding volume,shorter retention time of urinary tube and hospitalization time (P<0.05),while operation time in the two groups was statistically same.After operation,incidence of complications in group B was 3.2%,which was statistically lower than that of 15.4% in group A ( P<0.05).On admission and 1 week after operation,levels of VEGF of two groups had no significant differences.8 weeks and 6 months after operation,level of VEGF in group B was statistically lower than that in group A respectively (P<0.05).After the two-year follow-up,recurrence rate in group B was 4.8%,which was statistically lower than that of 17.3% in group A (P<0.05).Conclusion RevoLix 2μm laser combined with pirarubicine is effective for patients with non-muscular invasive bladder cancer with less bleeding volume,quicker postoperative recovery,lower incidence of complications and recurrence rate after operation.This may be related to the decrease of serum VEGF level in patients,it is necessary to further study.