非肌层浸润性膀胱尿路上皮癌预后的多因素Cox回归分析  

Multivariate Cox regression analysis for the prognosis of non-muscle invasive urothelial bladder cancer

作　　者：王兴[1,2] 崔曙[1] 朱平宇[1] 龚志勇[1] 唐铁龙[1] 邓显忠[1] 谷君卿[1] 

机构地区：[1]川北医学院附属医院泌尿外科,南充637000 [2]核工业四一六医院泌尿外科

出　　处：《临床泌尿外科杂志》2014年第10期878-881,共4页Journal of Clinical Urology

基　　金：四川省卫生厅项目(编号110318)

摘　　要：目的：探讨影响非肌层浸润性膀胱尿路上皮癌（non-muscle invasive bladder cancer,NMIBC）预后的主要相关因素及其临床意义。方法：采用回顾性分析的方法,分析川北医学院附属医院2008年1月-2011年6月间收治的174例非肌层浸润性膀胱尿路上皮癌患者的临床病例资料。患者的临床病理特征（单因素）对肿瘤复发和进展风险的影响采用Kaplan-Meier法和log-rank检验评估。选择单因素分析有意义的变量分别对肿瘤复发、疾病进展进行Cox比例风险回归模型的多因素生存分析。结果：单因素分析表明患者年龄、肿瘤个数、肿瘤分期、分级、肿瘤生长部位、术后是否即刻灌注及既往复发情况七项因素与肿瘤复发显著相关（P〈0.05）;肿瘤直径、肿瘤分期、分级、术后是否即刻灌注及既往复发情况五项因素与疾病进展相关（P〈0.05）。将上述各因素分别纳入Cox风险模型中得出各因素对肿瘤复发的相对危险度分别为：肿瘤分期（RR=2.041,P=0.046）、肿瘤分级（RR=1.548,P=0.037）、术后是否即刻灌注（RR=2.335,P=0.005）、既往复发情况（RR=1.484,P=0.048）;各因素对疾病进展的相对危险度分别为：肿瘤分级（RR=3.019,P=0.006）、肿瘤直径（RR=5.062,P=0.005）、既往复发情况（RR=2.345,P=0.012）。结论：与非肌层浸润性膀胱尿路上皮癌术后复发密切相关的因素包括肿瘤分期、分级、术后是否即刻灌注及既往复发情况,而膀胱肿瘤的直径、分级及既往复发情况对患者肿瘤的进展影响最大。Objective：To explore the main influencing factors and clinical significance of the prognosis of nonmuscle invasive urothelial bladder cancer.Method：Clinical data of 174 patients with non-muscle invasive urothelial bladder cancer treated in Affiliated Hospital of North Sichuan Medical College from January 2008 to June 2011 were analyzed retrospectively.Methods of Kaplan-Meier and log-rank test were used to assess the influencing degree of clinical and pathological features（single factor）on the tumor recurrence and progression risks.Cox proportional hazards regression model was used to analyse multivariate survival of the recurrence and progression of the disease through the significant variables of univariate analysis.Result：Univariate analysis showed that patients＇ age,tumor number,tumor stage,tumor grade,tumor location,postoperative immediate perfusion and past history of recurrence were significantly associated with the tumor recurrence（P 〈0.05）,and tumor diameter,tumor stage,tumor grade,postoperative immediate perfusion and past history of recurrence were significantly associated with the tumor progression（P〈 0.05）.Relative risks of tumor recurrence drawn from the above mentioned factors were included into the Cox risk model.Relative risks of every factor on tumor recurrence were as follows：tumor stage（RR=2.041,P=0.046）,tumor grade（RR=1.548,P=0.037）,postoperative immediate perfusion（RR=2.335,P =0.005）,past history of recurrence（RR=1.484,P =0.048）.Risk factors of every factor on tumor progression were as follows：tumor grade（RR=3.019,P =0.006）,tumor diameter（RR=5.062,P =0.005）,past history of recurrence（RR= 2.345,P =0.012）.Conclusion：Tumor stage,tumor grade,postoperative immediate perfusion and past history of recurrence are closely associated with the recurrence of non-muscle invasive urothelial bladder cancer.However,tumor diameter,tumor grade and past history of recurrence greatly influence the tumor progression.

关 键 词：非肌层浸润性膀胱尿路上皮癌 复发 进展 多因素分析 

分 类 号：R737.15[医药卫生—肿瘤]