Outcome,Prognosis And Analysis Of Patients With High-risk Non-muscle Invasive Bladder Cancer

ObjectiveFollow-up and report the treatment strategy,prognosis and outcome of patients with high-risk non-muscle invasive bladder cancer(NMIBC),and analyze the reasons that affect its outcome.MethodsA retrospective collection of 273 high-risk NMIBC patients from Nanjing Gulou Hospital between August 2012 and August 2016 was screened for inclusion and exclusion criteria,and 185 patients were finally included in the study.Collect the patient’s baseline data by consulting the medical records,and obtain the patient’s condition changes and survival conditions through outpatient services and telephone calls.ResultsThe follow-up time of 185 patients was 4-84 months,M(56 months),including160 male and 25 female;the average age was 65.76 ± 11.57 years.Their tumor stages were:70 cases were G3 tumors,79 cases were T1G3 tumors,6 cases were simple carcinoma in situ,13 cases were G3 / T1G3 combined with carcinoma in situ,2 cases were recurrent multiple large Ta G1 / 2 tumors,and 15 cases of pathological results combined with histological subtypes such as adenoid differentiation and squamous metaplasia.41 patients(22.16%)chose immediate radical cystectomy(RC)after the initial diagnosis of high-risk NMIBC.The 5-year tumor-specific survival rates of the immediate RC group and the bladder-preserving group were 94.3 ± 1.9% and 86.9 ±4.3%,respectively,with no statistical difference;however,the proportion of extremely high-risk subgroup in the two groups was statistically different(63.41%and 27.08%).The 5-year tumor progression-free survival rates of the extremely high-risk subgroup and the none-extremely-high-risk subgroup were 73.7 ± 6.9% and89.9 ± 3.1%,respectively;the difference was statistically significant.After group comparison,the tumor progression rates of the extremely high-risk subgroup and the none-extremely-high-risk subgroup were different,25.64% and 10.47%;while there was no difference between the extremely high-risk subgroup and the none-extremely-high-risk subgroup in RC patients immediately.11.54% and 13.33%.Among the 144 bladder-preserving patients,25 patients did not undergo re-TURBT.The remaining re-TURBT results were 106 cases of T0 / Ta stage and 13 cases of T1G3 / G3 / TIS stage;The 5-year tumor-specific survival rates of the T0 / Ta stage tumor group,T1G3 / G3 / TIS stage tumor group,and unresected group were 96.0%,72.7%,and 82.5%,respectively;the difference was statistically significant(P = 0.002);the mortality rates of the electrocision group and the non-electrocision group were also Statistical difference(P = 0.02).The 5-year tumor-specific survival rates of the immediate RC group and the delayed RC group were 59.5% and 95.1%,respectively,with statistical differences(P = 0.002).In addition,of the 41 patients who underwent immediate radical cystectomy(RC)after diagnosis of NMIBC,14 patients had carcinoma in situ that was not found in preoperative resection pathology,accounting for 34.15% of 41 cases.ConclusionThe extremely high-risk subgroup in high-risk NMIBC is more likely to progress when choosing a bladder-preserving treatment,and it is recommended to take a more aggressive treatment;Re-TURBT can help improve the survival rate of high-risk NMIBC;delayed RC compared with immediate RC survival Significantly reduced;missed diagnosis of TIS is worthy of attention,it is recommended to random biopsy mucosa or secondary electrotomy to increase the detection rate.