The Research On Clinical Features,Postoperative Intravesical Instillation And Recurrence Related Risk Factors Of IPB

Objective By investigating the general clinical characteristics,intravesical instillation therapy and follow-up results of patients diagnosed as inverted papilloma of the bladder(IPB).Aim to evaluate the recurrence risk factors of IPB patients and the necessity of postoperative intravesical instillation treatment,to provide clinical evidence for optimal treatment plan which could improve the prognosis and life quality after surgeries.Method 1.Collect information of 107 patients diagnosed as IPB from January 2010 to December 2015 in the Affiliated Hospital of Qingdao University.All patients received the surgery of transurethral resection of bladder tumor(TURBT)and their pathological results are all inverted papilloma of the bladder(IPB).Patients information include their general information,tumor characteristics and intravesical instillation treatment record.2.Patients were grouped according to the risk factors which were evaluated,postoperative recurrence free survival rate(RFS)was compared between different groups.Kaplan-Meier survival curves and Log-Rank single factor analysis were applied to target recurrence risk factors,risk factors with statistical significance were further analyzed in multivariate analysis of the Cox proportional hazard model.Results This study included 107 cases of IPB patients who received surgery of TURBT,the median follow-up time was 56 months.Among them,there are 87 males(81.3%)and 20 females(18.7%),the age distribution is 18-88 years(mean age: 52 years),70 people(65.4%)have smoking history and 52(48.6%)have alcohol drinking history;Clinical manifestations of painless gross hematuria 46(43%),urinary tract irritation 10(9.35%),lower abdomen and lumbosacral pain discomfort 10 people(9.35%),dysuria 3(2.8%),38 cases(35.5%)were asymptomatic.101 cases(94.4%)were diagnosed with single tumor and 6 cases were with multiple tumors(5.6%).Tumors were located at the bladder neck and triangular region in 69 cases(64.5%).In the other 38 cases(35.5%),tumors were located in other regions of bladder.89 cases(83.2%)with tumor diameter <3cm,18 cases(16.8%)with tumor diameter≥3cm,and 86(80.4%)with papillary tumor.There were 21 follicular samples(19.6%),76 patients(71.0%)received early bladder irrigation,31 patients(29.0%)without early bladder irrigation.69 patients(64.5%)received long-term bladder irrigation,38 patients(35.5%)without long-term bladder irrigation.Postoperative recurrence occurs in 3 patients(2.8%),malignant transform-ation occurs in 5 patients(4.7%).Kaplan-Meier survival curve analysis and Long-Rank analysis were applied in the study on the variables related to the postoperative recurrence free survival rate(RFS)in IPB patients.Single factor analysis shows: the presence of clinical symptoms(P=0.030),maximum tumor diameter over 3cm(P=0.001),multiple tumors(P=0.008)were risk factors for postoperative reccurrence.Further multivariate analysis by Cox risk model shows that maximum tumor diameter over 3cm(HR=4.577,95%CI:1.083-19.351,P=0.039)multiple tumors(HR=6.301,95%CI:1.175-33.795,P=0.032)were risk factors for postoperative reccurrence.Long-term postoperative intravesical therapy is not statistically significant in RFS(P=0.342).Conclusion 1.The clinical occurrence rate of IPB is relative low,IPB occurs more often in middle-aged male patients than female.The tumor always located in the neck of the bladder and triangle region,most of the lesions are single ones with papillary appearance and diameter less than 3cm.Prognosis of IPB are generally good,the rate of recurrence and maliganant transformation is low.2.In view of IPB malignant potential,long-term follow-up after surgery is essential.Patients with multiple tumors and the diameter of tumor more than 3cm,should be regarded as high-risk cases,whose follow-up should be more strict,frequent,and with longer time,to detect the occurrence and development of the lesions.3.Long-term regular intravesical instillation in postoperative IPB patients has little effect in preventing its recurrence and malignant transformation,and also has little therapeutic effect.But this study is a single center study with small number of cases.Multi-center study with large number of patients should be conducted for verification.