pT1膀胱尿路上皮癌MM-VP亚分期与术后淋巴转移的相关性分析  

Correlative analysis of MM-VP sub-stage and postoperative lymph node metastasis of pT1 bladder urothelial carcinoma

作　　者：张浩然 刘春辉 盛永亮 邢俊杰 李志军[1] Zhang Haoran;Liu Chunhui;Sheng Yongliang;Xing Junjie;Li Zhijun(Clinical Medical College of Henan University of Science and Technology(Department of Urology,the First Affiliated Hospital of Henan University of Science and Technology),Luoyang 471000,China)

机构地区：[1]河南科技大学临床医学院(河南科技大学第一附属医院泌尿外二科),洛阳471000

出　　处：《国际泌尿系统杂志》2024年第6期1028-1032,共5页International Journal of Urology and Nephrology

摘　　要：目的探究pT1膀胱尿路上皮癌肿瘤浸润黏膜肌-血管丛(MM-VP)亚分期与术后淋巴转移的相关性。方法选取2018年1月至2021年1月于本院接受经尿道膀胱肿瘤电切术治疗的129例pT1期膀胱尿路上皮癌(BUC)患者作为研究对象,依据随访期间是否发生淋巴转移将患者分为转移组(45例)和未转移组(84例)。通过单因素和多因素logistic回归分析患者术后发生淋巴转移的影响因素。依据MM-VP亚分期的不同对患者进行分类,分析MM-VP亚分期与患者临床病理特征、术后淋巴转移的关系。依据独立因素构建列线图预测模型并验证。使用X-tile软件确定预测模型的截断值,建立Kaplan-Meier生存曲线。结果与T1a期的患者比较,MM-VP亚分期为T1b期的患者肿瘤数量较多、肿瘤长径较大、肿瘤分级较低、术后淋巴转移发生率较高(均P<0.05);MM-VP亚分期与肿瘤数量、肿瘤长径、肿瘤分级以及淋巴转移存在显著相关关系(均P<0.05)。单因素logistic回归分析结果显示,两组患者的年龄、吸烟、MM-VP亚分期、肿瘤数量、肿瘤长径、肿瘤分级比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,MM-VP亚分期、肿瘤数量、肿瘤长径、肿瘤分级为术后发生淋巴转移的独立影响因素(均P<0.05)。采用独立影响因素构建患者术后淋巴转移的列线图预测模型,模型具有良好的区分度、准确性和临床适用性。淋巴转移的危险分层建立的生存曲线结果显示,≥171分(高风险)患者术后发生淋巴转移的风险最高。结论MM-VP亚分期与肿瘤数量、肿瘤长径、肿瘤分级以及淋巴转移存在显著相关关系,为术后淋巴转移的独立影响因素,MM-VP亚分期为T1a患者的预后情况显著优于T1b患者。ObjectiveExploring the correlation between mucosal musculus-vascular plexus(MM-VP)sub-stage and postoperative lymph node metastasis in pT1 bladder urothelial carcinoma.MethodsA retrospective study was conducted on 129 patients with pT1 stage bladder urothelial carcinoma(BUC)who underwent transurethral resection of bladder tumors at our hospital from January 2018 to January 2021.All patients were divided into metastatic group(45 cases)and non-metastatic group(84 cases)according to whether lymphatic metastasis occurred during follow-up.The influencing factors of postoperative lymphatic metastasis were analyzed by univariate and multivariate logistic regression.The patients were categorized based on the distinct sub-stages of tumor invasion in theMM-VP,and an analysis was conducted to examine the correlation between MM-VP sub-stage,clinicopathological features,and postoperative lymph metastasis.An independent factor-based nomogram prediction model was developed and validated.The truncation value for the prediction model was determined using X-tile software,and a Kaplan-Meier survival curve was established.ResultsCompared with T1a patients,patients with MM-VP sub-stage T1b had more tumors,larger tumor diameter,lower tumor grade,and higher incidence of postoperative lymphatic metastasis(all P<0.05).MM-VP sub-stage was significantly correlated with tumor number,tumor length,tumor grade and lymph metastasis(P<0.05).The results of univariate logistic regression analysis showed that there were statistically significant differences in age,smoking,MM-VP sub-stage,tumor number,tumor length and tumor grade between the two groups(all P<0.05).Multivariate logistic regression analysis showed that MM-VP sub-stage,tumor number,tumor length diameter and tumor grade were independent influencing factors for postoperative lymph metastasis(all P<0.05).The nomogram prediction model of postoperative lymphatic metastasis was established by using independent influencing factors.The model has good differentiation,accuracy and clinical appli

关 键 词：膀胱 尿路上皮癌 肿瘤浸润黏膜肌-血管丛 淋巴转移 

分 类 号：R737.14[医药卫生—肿瘤]