膀胱小细胞癌临床病理特征及新辅助治疗疗效  

Clinical and pathological characteristics of small cell carcinoma of bladder and the efficacy of neoadjuvant therapy

作　　者：阿克周力·沙哈提艾力 钱雷 张天祥 金迪[1] 张瑞赟 陈海戈[1] AKEZHOULI Shahatiaili;QIAN Lei;ZHANG Tianxiang;JIN Di;ZHANG Ruiyun;CHEN Haige(Department of Urology,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院泌尿科,上海200127

出　　处：《现代泌尿外科杂志》2023年第6期474-479,共6页Journal of Modern Urology

基　　金：国家自然科学基金项目(No.82173076)。

摘　　要：目的探索膀胱小细胞癌(SCCB)的临床特征、预后因素以及新辅助治疗疗效。方法收集2012年1月-2022年9月上海交通大学医学院附属仁济医院泌尿科收治的47例SCCB患者的临床资料。通过与尿路上皮癌肿瘤对比,探讨SCCB临床病理特征;进一步通过非转移性膀胱小细胞癌队列(37例)分析其预后相关因素及新辅助治疗在非转移性SCCB治疗中的应用。结果SCCB基线期肿瘤分期高,易发生肌层浸润(100%)及远处转移(21.3%),总生存期短(中位生存时间13.1个月,1年生存率53.7%,5年总生存率15.4%)。肿瘤T分期为SCCB患者的预后危险因素,术前接受新辅助治疗为独立保护因素,能显著降低其复发转移风险(HR=0.189,95%CI:0.051~0.697,P=0.012)及患者死亡风险(HR=0.177,95%CI:0.045~0.698,P=0.013),显著提高患者的无疾病生存期以及总生存时间。此外,相比单纯新辅助化疗,新辅助化疗联合免疫治疗能提高SCCB的病理完全缓解率。结论SCCB恶性程度高、易转移、预后差,推荐将新辅助治疗联合膀胱根治性切除术作为SCCB的首选治疗方案。Objective To investigate the clinical characteristics and prognostic factors of small cell carcinoma of bladder(SCCB),and to explore the efficacy of neoadjuvant therapy.Methods Clinical information of 47 SCCB patients were retrospectively collected,and the clinical and pathological features were compared with those of urothelial carcinoma(UBC).The prognostic factors and efficacy of neoadjuvant therapy were also investigated.Results SCCB had higher baseline tumor staging,and was more likely to invade the muscle(100%)and metastasize distantly(21.3%).The overall survival was poor(median:13.1 months,1-year survival rate:53.7%,5-year overall survival rate:15.4%).Tumor T staging was a risk factor for SCCB,while neoadjuvant therapy was an independent protective factor that significantly reduced the risk of recurrence and metastasis(HR:0.189,95%CI:0.051-0.697,P=0.012)and death(HR:0.177,95%CI:0.045-0.698,P=0.013),and significantly improved disease-free survival and overall survival.In addition,compared with neoadjuvant chemotherapy alone,neoadjuvant chemotherapy combined with immunotherapy could improve the pathological complete response rate.Conclusion SCCB is highly malignant and prone to metastasis,and has a poor prognosis.Neoadjuvant therapy combined with radical cystectomy is recommended as the first-line treatment.

关 键 词：膀胱小细胞癌 临床病理特征 预后因素 新辅助治疗 免疫治疗 

分 类 号：R737.14[医药卫生—肿瘤]