尿路上皮癌变异型对根治性膀胱切除术患者预后的影响  

Impact of variant differentiation on patient survival after radical cystectomy in urothelial carcinoma of the bladder

作　　者：葛鹏[1] 王子成[1] 李森[1] 喻希[1] 何群[1] 刘漓波[1] 苏晋伟[1] 林健[1] 

机构地区：[1]北京大学第一医院泌尿外科北京大学泌尿外科研究所,100034

出　　处：《中华泌尿外科杂志》2015年第7期490-494,共5页Chinese Journal of Urology

摘　　要：目的 探讨尿路上皮癌组织学变异型对根治性膀胱切除术患者预后的影响.方法 回顾性分析2006年1月至2012年12月收治的418例行根治性膀胱切除术＋淋巴结清扫术的尿路上皮癌患者的病理资料.根据手术标本病理结果将患者分为3组：A组为单纯尿路上皮癌262例,B组为尿路上皮癌伴鳞样和/或腺样分化103例,C组为尿路上皮癌伴非鳞样和/或腺样变异型53例.运用Kaplan-Meier、Log-rank检验和Cox比例风险模型分析3组的肿瘤特异性生存率和总生存率的差异.结果 本组418例中,156例病理诊断有组织学变异型,其中108例伴1种变异型,48例伴多种变异型.单一变异型包括：鳞状分化48例（11.5％）,腺样分化40例（9.6％）,肉瘤样分化13例（3.1％）,微囊变异型3例（0.7％）,淋巴上皮样瘤样癌2例（0.5％）和透明细胞变异型2例（0.5％）.B组和C组较A组更易具有高分期肿瘤[T4期肿瘤分别为29例（28.2％）、14例（26.4％）、24例（9.2％）]、淋巴结转移[分别为35例（34.0％）、13例（24.5％）、31例（11.8％）]和脉管浸润[分别为45例（43.7％）、22例（41.5％）、49例（18.7％）],差异均有统计学意义（P ＜0.017）.单因素分析结果显示,B组和C组的肿瘤特异性生存率和总生存率均低于A组（P均＜0.01）.多因素分析结果显示,C组与肿瘤特异性生存率（风险比2.49,95％ CI：1.32 ～4.67,P＜0.01）和总生存率（风险比2.21,95％ CI：1.31 ～3.73,P＜0.01）相关.结论 尿路上皮癌伴变异型是根治性膀胱切除术患者预后独立影响因素,伴尿路上皮癌变异型患者预后较差.Objective To find out the impact of variant histologic differentiation of patients with urothelial carcinoma of the bladder on survival after radical cystectomy.Methods Between 2006 and 2012,418 consecutive patients who underwent radical cystectomy with lymphadenectomy for urothelial carcinoma of the bladder were included.The patients were divided into three groups：group A included 262 patients with pure urothrothial carcinoma,group B included 103 patients with squamous and/or glandular differentiation and group 3 comprised 53 patients with non-squamous and/or glandular differentiation.Cancer-specific and overall survivals were compared using Kaplan-Meier method,Log-rank test and multivariable Cox proportional hazard regression analyses.Results Of the 418 patients,108 were diagnosed with a single variant histology,and 58 had multiple patterns.Squamous differentiation （n =48;11.5%） was the most common single variant histology,followed by glandular （n =40;9.6%） and sarcomatoid（n =13;3.1%）.Compared to group A,group B and C were more likely to have advanced tumor stage（pT4 in group B vs group C vs group A：29,14,24;28.2% vs 26.4% vs 9.2%）,lymph node metastases（35,13,31;34.0% vs 24.5% vs 11.8%）and lymphovascular invasion （45,22,49;43.7% vs 41.5% vsl8.7%） （P-values 〈 0.017）.In univariable analyses,group B and group C were at significantly higher risk for cancer specific mortality and overall mortality than patients with pure UCB （P-values 〈 0.01）.In multivariable analyses,group C had significantly prognostic influence in cancer-specific mortality （HR 2.49,95% CI 1.32-4.67,P 〈 0.01） and overall mortality （HR 2.21,95% CI 1.31-3.73,P 〈 0.01）.Conclusion Variant differentiation was independently associated with adverse outcomes for patients with urothelial carcinoma of the bladder after radical cystectomy.

关 键 词：尿路上皮癌 病理 预后 根治性膀胱切除术 变异型 

分 类 号：R737.1[医药卫生—肿瘤]