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在患有初级高度Ta NMIBC的患者中,特别是在初始病例的背景下,是否需要第二次TUR?

Satoki Abe¹, Hiroyuki Fujinami¹, Naoyuki Yamanaka¹

¹Department of Urology, Faculty of Medicine Oita University Yufu Oita Japan.

|September 16, 2025

概括

如果初始手术已经完成,初级高度Ta膀癌患者可能不需要进行第二次膀瘤透尿切除 (TURBT). 这种方法可以减少手术,而不会影响癌症的结果.

科学领域:

泌尿器科泌尿器科泌尿器科泌尿器科
在瘤学瘤学.
手术病理学手术病理学

背景情况:

非肌肉侵入性膀癌 (NMIBC) 管理通常涉及膀瘤的顺尿管切除 (TURBT).
高度 (HG) Ta NMIBC 需要仔细分阶段和治疗以防止进展.
第二个TURBT在特定NMIBC亚型中的作用仍然是临床辩论的主题.

研究的目的:

在初级高度Ta NMIBC患者中评估第二次TURBT的临床意义.
确定第二次TURBT是否影响无复发生存率 (RFS),进展到肌肉侵入性膀癌 (MIBC) 的时间,或癌症特异性生存率 (CSS).
在初级 HG Ta NMIBC 的选定病例中,评估遗漏第二次 TURBT 的瘤安全性.

主要方法:

对121名患有原发性HG Ta泌尿腺癌的患者进行了回顾性分析.
患者被分为第二个TURBT组 (n=48) 和非第二个TURBT组 (n=73).
倾向性得分匹配用于控制混变量;结果包括残留瘤率,RFS,MIBC进展时间和CSS.

主要成果:

在接受第二次TURBT的8.3%的患者中发现了残留瘤,其中4.2%的患者升级到T1.
在RFS (p=0.60),MIBC进展时间 (p=0.63) 或CSS (p=0.18) 中没有观察到群体之间的显著差异.
多变量分析证实,第二次TURBT与改善的RFS无关.

结论:

这项研究表明,在某些患有原发性HG Ta膀癌的患者中,可以省略第二次TURBT,特别是在进行完整的初始切除后,并采用适当的dtrusor肌肉样本.
适应风险的策略可以减少不必要的干预,同时保持瘤安全.
这是第一个专门评估原发性HG Ta膀癌的研究,支持临床实践的潜在变化.

关键词:

高度的Ta瘤高度的Ta瘤非肌肉侵袭性膀癌是什么?没有复发的生存率.剩余的瘤发生率第二次通过尿道切除.

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