53例膀胱腺癌的临床特征及预后相关因素分析  

Analysis of clinicopathological features and prognosis of adenocarcinoma of bladder in 53 cases

作　　者：翟天元 罗彬杰 贾占奎[1] 李松超[1] 丁暄 丁映辉 邢会武 李红坤 杨锦建[1] ZHAI Tianyuan;LUO Binjie;JIA Zhankui;LI Songchao;DING Xuan;DING Yinghui;XING Huiwu;LI Hongkun;YANG Jinjian(Department of Urology,The First Affiliated Hospital of Zhengzhou University,Henan Institute of Urology,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院泌尿外科,河南省泌尿外科研究所,郑州450052

出　　处：《实用医学杂志》2018年第14期2393-2397,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金面上项目(编号:81570685)

摘　　要：目的探讨膀胱腺癌的临床特征及与预后的关系。方法回顾性分析2011年8月至2015年1月收治的53例病理确诊为膀胱腺癌(包括非脐尿管腺癌和脐尿管腺癌)患者的临床资料。采用Kaplan-Meier生存分析法计算患者的生存率,Log-rank检验生存率差异,应用COX比例回归风险模型分析影响预后的临床因素。结果男39例,女14例,男女比例为2.79∶1。年龄28~89岁,平均(54.85±14.30)岁。p T1期肿瘤患者15.1%(8/53),p T2期67.9%(36/53),p T3期11.3%(6/53),p T4期5.7%(3/53)。肿瘤最大径3~90 mm,中位肿瘤最大径为35.00 mm。总体随访率71.7%,53例的随访时间为8~75个月,中位随访时间27.3(12.0,51.5)个月,1、3年生存率分别为82.0%(44/53),61.6%(37/53)。单因素结果分析显示性别(P=0.047)、年龄(P=0.032)、化疗(P=0.041)、淋巴结转移(P=0.010)、远处转移(P=0.023)、病理分级(P=0.034)、职业(P<0.001)是影响膀胱腺癌生存期的因素。COX多因素分析示性别(RR=4.17,P=0.026)、年龄(RR=6.00,P=0.015)、化疗(RR=10.30,P=0.005)、淋巴结转移(RR=9.15,P=0.032)是影响膀胱腺癌患者生存时间的独立因素。结论膀胱腺癌就诊时大多数已属局部晚期,临床上肿瘤分期以p T2~p T4期多见(45/53),这可能和预后较差有关。COX多因素分析结果显示性别(RR=4.17,P=0.026)、年龄(RR=6.00,P=0.015)、化疗(RR=10.30,P=0.005)、淋巴结转移(RR=9.15,P=0.032)是影响膀胱腺癌患者生存时间的独立因素。Objective To analyze long-term survival of adenocarcinoma of bladder and its prognostic factors.Methods During August 2011 and January 2015,53 cases of adenocarcinoma of bladder(including both nonurachal adenocarcinoma and urachal adenocarcinoma)patients were reviewed and their clinicopathological data along with the follow-up investigations were retrospectively analyzed.The survival rate was calculated by Kaplan-Meier method.Prognostic factors were assessed by the Log-rank test.The COX model multivariate survival was used to analyze the relationship between the clinicopathological influence factors and the prognosis.Results 53 cases were divided into 39 males and 14 females,and the M/F ratio is 2.79:1,aged 28~89 with the average age of(54.85±14.30)years.Tumor staging was pT1 in 8(15.1%),pT2 in 36(67.9%),pT3 in 6(11.3%)and pT4 in 3(5.7%).The size of lesion was 3~90 mm,with median at 35.00 mm.The overall follow-up rate was 71.7%.The median follow-up time was 27.3(12.0,51.5)months(ranged from 8 to 75 months).The 1-year,3-year overall survival was 82.0%(44/53),61.6%(37/53)respectively.Single factor analysis showed that sex(P=0.047),age(P=0.032),chemotherapy(P=0.041),lymph node metastasis(P=0.010),distant metastasis(P=0.023),grade(P=0.034)and profession(P<0.001)were significant prognostic factors in Log-rank test.According to the COX multivariate analysis,sex(RR=4.17,P=0.026),age(RR=6.00,P=0.015),chemotherapy(RR=10.30,P=0.005)and lymph node metastasis(RR=9.15,P=0.032)were independent predictive factors.Conclusions Adenocarcinoma of bladder is a rare subtype of bladder tumor,and the pT2 to the pT4 cases are dominant in all cases,which may lead to the poor prognosis.Sex,age,chemotherapy and lymph node metastasis are independent prognostic factors of adenocarcinoma of bladder according to the COX multivariate analysis.

关 键 词：膀胱肿瘤 膀胱腺癌 生存分析 临床特征 预后 

分 类 号：R737.14[医药卫生—肿瘤]