| ObjectiveWith the multifactor analysis on several clinical data,combining with the TCM syndrome factors of the bladder cancer,exploring the potential risk or the protective factors for non muscle-invasive bladder cancer' s progression within 5 years.This thesis could be the guideline for clinical practice.What' s more,it will explore the connection between the TCM syndrome type and the progression of non muscle-invasive bladder cancer.With a reasonable expectation,a different angle might be provided to the others potential clinical studies and some new ideas of syndrome differentiation when facing the bladder cancer' s treatment.MethodsIn this paper,a case-control study method will be used.According to certain exclusion criteria and inclusion criteria,74 cases were retrospectively coll ected.74 cases were deemed as the comparison group.There are totally 148 cases included.The.case group and the control group came from The First Affiliated Hospital of Traditional Chinese Medical University of Guangzhou and the Guangdong Provincial Hospital of Traditional Chinese Medicine,looking for bladder cancer patients from these two hospitals from 2011-01 to 2018-12.All patients were treated with TUR-BT and using the intravesical instillation treatment within 24 hours after surgery,postoperative pathological staging is Ta or T1.Patients who progress to the T2 or higher stage' s bladder cancer within 5 years were classified as a case group,and patients diagnosed as Ta or T1 bladder cancer who did not progress within 5 years were classified as a control group.Collecting the following relevant clinical data and diagnosis:age,gender,history of smoking,pathological stage of first diagnosis,tumor size,neutrophil-lymphocyte ratio in preoperative peripheral blood(NLR),postoperative the number of bladder perfusion treatments,the number of postoperative recurrences,tumor grade,and the second TUR-BT history.Then the author will put the data into the Microsoft Office Excel worksheet and build the database.Then,PASS11 calculated the sample size,taking a=0.05,0=0.1.Then SPSS 22.0 for statistics,and input the measurement data into the software SPSS22.0.The specific statistical steps are as follows:1.Obtaining descriptive statistics for the general information about the clinically relevant data required in this paper.The measurement data is represented by“x±s”,and the counting data can be obtained by the four-grid table and the percentage is expressed.2.Descriptive statistics were used to obtain the distribution patterns of syndrome types in patients with Ta or T1 stage of NMIBC and the distribution pattern and characteristics of the syndromes of Patients who progress to the T2 or higher stage's bladder cancer within 5 years.3.Single factor analysis:Classification of the system counting data or measurement data in the relevant clinical data collected in this paper.The data whose count data belongs to the disordered categorical variable needs to be analyzed by chi-square test,and other data belonging to the ordered grade variable can be tested by rank sum test.The significance level is a=0.05.All data in the measurement data that conform to the normal distribution and the homogeneity of the variance are tested by T test,while other data that do not conform to the normal distribution are tested by rank sum.4.Multi-factor analysis:This paper will apply binary logistic regression analysis method,and all the statistically significant clinical factors in the univariate analysis will be included in the logistic regression analysis for multi-factor analysis,obtain the OR value,and explore NMIBC,and we can get the result which mirrors that the relationship behind the progression.ResultsGeneral Date:148 patients in this study met the diagnostic criteria and the relevant inclusion criteria,exclusion criteria,and ratios established in this paper,and then included these patients in this topic.However,due to lack of data,death of the patient,etc.,data were missing in 4 cases,so the total number of cases in this paper was 144 cases.General information about the case group:Patients who progressed to MIBC and who were included into the case group.The mean age of the case group was 63.76±13.83 years,of which the youngest was 36 years old and the oldest was 88 years old.The mean number of postoperative recurrences was 1.46±0.96.The mean number of postoperative bladder perfusion treatments was 7.29±2.52 times.There were 29 females in the case group,accounting for 41.1%;41 males,accounting for 58.6%.There were 51 patients with a history of smoking,accounting for 72.9%;19 patients with no smoking history,accounting for 27.1%.The number of patients with the first diagnosis pathological stage of T1 was 64,accounting for 91.40%;the Ta period was 6 people,accounting for 8.6%.Among the tumor size,32 people were?3 cm,accounting for 45.7%of the total number of cases,and 38 people,more than 3 cm,accounting for 54.3%.In terms of the ratio of NLR in peripheral blood,the NLR=2.4 was selected as the critical value,>2.4 was 37,accounting for 52.9;33 were<2.4,accounting for 47.1.%.There were 65 patients with high grade tumors,accounting for 92.9%,and 5 patients with low grades,accounting for 7.1%.There were 14 patients with re-excision,accounting for 20%;patients without twice TUR-BT count to 56 people,accounting for 80%.Regarding the general situation of the control group:the first-stage pathological stage was T1,Ta stage of NMIBC,and there was a sub-group of patients who met the inclusion criteria.The mean age of the control group was 62.68±12.4 years,the youngest was 41 years old,and the oldest patient was 87 years old.The mean number of postoperative recurrences was 0.09±0.29 times.The mean number of intravesical instillation treatments after surgery was 7.01±2.52 times.In the control group,52 males,accounting for 70.3%;22 females,accounting for 29.70%.There were 30 patients with a history of smoking,accounting for 40.5%;44 patients with no history of smoking,accounting for 59.5%.There were 27 patients with a pathological stage of the first diagnosis,accounting for 36.5%,and 47 patients with a T1 phase,accounting for 63.5%.The number of patients with tumor size?3cm was 60.8%,and that of>3cm was 29,accounting for 60.8%.In the preoperative peripheral blood neutrophil-lymphocyte ratio(NLR),there were 28 people with>2.4,accounting for 37.8%;46 patients with?2.4,accounting for 62.2%.In the control group,there were 20 patients with high grade tumors,accounting for 27%;54 patients at low level,accounting for 73%.There were 19 people who performed TUR-BT twice in 2-6 weeks,accounting for 25.7%;there were 55 people who did not undergo resection,accounting for 74.3%.TCM syndrome type distribution:Among the 144 patients,there were 53 people with syndromes of spleen and kidney deficiency,accounting for 36.81%of the total cases.There are 18 people with qi and yin deficiency,accounting for 12.5%.There were 45 cases of hot and humid bet,accounting for 31.25%.There are 28 people who have accumulated anti-drugs,accounting for 19.44%.In the case group,there were 13 people with hot and humid bets,accounting for 18.6%;11 with scorpion venom,accounting for 15.7%;42 with spleen and kidney deficiency,accounting for 60%.There are 4 people with qi and yin deficiency,accounting for 5.7%.In the control group,there were 32 people with hot and humid bets,accounting for 43.2%;17 people with scorpion venom,accounting for 23%;11 people with spleen and kidney deficiency,accounting for 14.9%.There are 14 people with qi and yin deficiency,accounting for 18.9%.Univariate analysis:In the single factor analysis of this article,the number of recurrences,tumor grade,first diagnosis,history of smoking,and pathological stage of the first diagnosis were statistically significant(P<0.05).There was no statistically significant difference in age,gender,NLR,whether TUR-BT was performed within 2-6 weeks after the first TUR-BT,tumor size,and whether the bladder was maintained after surgery.Multivariate analysis:This paper used binary logistic regression equation analysis.The case group and the control group were statistically significant in the first diagnosis type,the number of postoperative recurrences,tumor grade,and the first pathological stage(P<0.05).The syndrome type of TCM can be seen after statistical analysis.Only the syndrome type of spleen and kidney deficiency has statistical significance,?=5.580>0,OR=265.181>1,the number of postoperative recurrences ?=4.487>0,OR=88.850>1;tumor grade ?=4.344>0,OR=77.006>1;?=4.386>0,OR=80.283>1 of the pathological stage of the first diagnosis.ConclusionFrom the TCM syndrome type,the distribution of TCM syndrome types in the case group between the case group and the non-progression control group were different.In the case group,the proportion of spleen and kidney deficiency was significantly higher than that in the control group.In the case group,dialectic was the spleen and stomach.Patients with deficiency are the most common,followed by hot and humid bets and scorpion venom.The most uncommon is qi and yin deficiency.In the control group,the most common syndrome type was hot and humid bet,followed by scorpion venom,spleen and kidney deficiency,and qi and yin deficiency.According to the statistical analysis,the first diagnosis of patients with spleen and kidney deficiency,compared with the baseline dummy variable Qi and Yin deficiency syndrome,the risk of progression to MIBC within 5 years is significantly increased,so the spleen and kidney deficiency may be NMIBC5 Risk factors for progress during the year.The clinical factors of tumor grade,first-stage pathological staging,and postoperative recurrence were statistically analyzed.The ?>0,indicating that for NMIBC patients,the number of postoperative recurrences,tumor grade,and pathological staging of the first diagnosis were Possible risk factors for its progress.Patients with lower-grade NMIBC who have a high grade of NMIBC are more likely to progress.Patients with first-stage pathological stage T1 were more likely to progress than patients with stage Ta.The greater the number of postoperative recurrences,the greater the likelihood that NMIBC patients will progress. |
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