男性膀胱癌术后复发的多因素分析  

Multivariate analysis of postoperative recurrence on the male bladder cancer

作　　者：郑昱[1] 张龙龙[1] 叶永利[1] 魏迪[1] 闫飞[1] 袁建林[1] 

机构地区：[1]第四军医大学西京医院泌尿外科,西安710032

出　　处：《现代泌尿生殖肿瘤杂志》2015年第2期76-81,共6页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的：探讨男性膀胱癌患者术后复发的相关危险因素，指导临床对男性膀胱癌患者术后复发的预防。方法回顾性分析72例男性膀胱癌术后5年复发的患者，利用 Kruskal-Wallis H 检验、Log-rank 检验、Kaplan-Meier 法及多因素 COX 回归分析对常见的15个临床、病理变量进行统计分析。结果所有患者的中位无肿瘤生存期为12个月（95％CI 10.347-13.653）。术后1、5年复发率分别为55.6％及87.5％。多因素分析结果显示首次发病年龄、术前吸烟史、肿瘤分期、复发时临床症状与男性膀胱癌患者术后复发相关。基于以上4种变量将患者分为低危组、中危组及高危组，各组中位无肿瘤生存期差异有统计学意义（P =0.006）。结论首次发病年龄≥61岁、术前有吸烟史、病理分期≥T2期及复发时无症状为男性膀胱癌术后复发的独立危险因素，基于以上4种危险因素的评分系统能够指导临床对男性膀胱癌患者术后复发的预防。Objective To identify the risk factors of postoperative recurrence for male patients with bladder cancer and to guide the clinical prevention for these patients. Methods We retrospec-tively analyzed the data of 72 patients with bladder cancer in Xijing hospital treated by surgical opera-tion who subsequently had recurrence within 5 years.The Kruskal-Wallis H test ,Kaplan-Meier method with the log rank test and multivariate Cox regression models were used to address disease free survival after surgery with 1 5 clinicopathological variables. Results Median disease free sur-vival in the 72 patients was 12.0（95%CI 10.347-13.653）months.One and 5-year recurrence rates were 55.6% and 87.5%,respectively.On multivariate analysis the variables associated with postop-erative recurrence including age at first onset,preoperative smoking history,tumor pathologic stage and symptoms at recurrence.Based on the 4 variables we constructed a risk model that classified pa-tients into favorable risk,intermediate risk and poor risk groups with significantly different disease free survival（P =0.006）. Conclusions First onset age 61 or higher,preoperative smoking histo-ry,tumor pathologic stage≥T2 ,asymptomatic recurrence were independent risk predictors of blad-der cancer postoperative recurrence.The risk model based on the 4 variables could be useful to pro-vide relevant prognostic information to patients and clinicians for preventing bladder cancer postoper-ative recurrence.

关 键 词：膀胱肿瘤 复发 危险因素 

分 类 号：R737.14[医药卫生—肿瘤]