目的:非肌层浸润性膀胱癌(NMIBC)约占膀胱癌病例的75%。经尿道原发性电切术(TUR)在诊断和治疗中起着至关重要的作用。然而,尽管最初切除,肿瘤经常被遗漏,留下微小的残留肿瘤。这项研究旨在前瞻性地调查肿瘤的手术边缘,这可能是残留肿瘤的潜在来源。
方法:本研究纳入了70例诊断为NMIBC并接受原发性TUR的患者。初次切除后,从超出手术边缘1cm的正常粘膜中收集样本.病变被归类为良性病变的“健康边缘”,尿路上皮癌的肿瘤边缘,和尿路上皮发育不良的发育不良边缘。比较两组患者的临床病理特征,并分析了在正常粘膜中检测移行细胞癌(TCC)的危险因素。
结果:与健康边缘组相比,肿瘤边缘组T1期肿瘤的发生率明显更高,与增生边缘组相比,高级别(HG)肿瘤的发生率明显更高。此外,与其他组相比,肿瘤边缘组的高危患者比例明显更高(85.7%),而与肿瘤边缘组(0.0%)相比,健康边缘组的低危患者比例(35.3%)明显更高.此外,与健康边缘组相比,肿瘤边缘组显示出明显更高的原位癌(CIS)发生率(35.7%vs.5.9%)。边缘尿路上皮癌的检测与T1期相关,HG阶段,以及基于单变量分析的CIS的存在。
结论:为了最大限度地减少原发TUR患者的残余肿瘤并防止复发,我们主张切除具有近2厘米完整膀胱组织的肉眼可见肿瘤,从而提高TUR的质量。
OBJECTIVE: Non-muscle invasive
bladder cancers (NMIBC) constitute approximately 75% of
bladder cancer cases. Primary transurethral resection (TUR) plays a pivotal role in both diagnosis and treatment. However, despite initial resection, tumors are often missed, leaving behind microscopic residual tumors. This study aims to prospectively investigate the surgical margins of tumors, which may serve as a potential source of residual tumors.
METHODS: Seventy patients diagnosed with NMIBC who underwent primary TUR were enrolled in this study. Following initial resection, samples were collected from the normal-appearing mucosa extending 1cm beyond the surgical margins. Lesions were categorized as \'healthy margins\' for benign lesions, \'tumoral margins\' for urothelial cancer, and \'dysplastic margins\' for urothelial dysplasia. Clinical and pathological features of these groups were compared, and risk factors for detecting transitional cell carcinoma (TCC) in the normal-looking mucosa were analyzed.
RESULTS: The tumoral margins group showed a significantly higher rate of T1 stage tumors compared to the healthy margins group, and a significantly higher rate of high-grade (HG) tumors compared to the dysplastic margins group. Moreover, the tumoral margins group had a significantly higher proportion of high-risk patients (85.7%) compared to the other groups, while the healthy margins group had a significantly higher proportion of low-risk patients (35.3%) compared to the tumoral margins group (0.0%). Additionally, the tumoral margins group demonstrated a significantly higher rate of carcinoma in situ (CIS) compared to the healthy margins group (35.7% vs. 5.9%). Detection of urothelial cancer at the margins was associated with T1 stage, HG stage, and the presence of CIS based on univariate analyses.
CONCLUSIONS: To minimize residual tumors and prevent recurrence in patients undergoing primary TUR, we advocate for the resection of macroscopically visible tumors with nearly 2cm of intact
bladder tissue, thereby enhancing the quality of TUR.
METHODS: This study provides Level II evidence, based on its design as a prospective observational study. The findings are derived from well-designed cohort analyses, providing significant associations and insights into the factors affecting surgical margins in NMIBC patients.