分化型与普通型膀胱尿路上皮癌预后情况比较  

Comparison of Prognosis between Differentiated and Common Bladder Urothelial Carcinoma.

作　　者：水源 赖龙辉 马文涛 任学兆 王志平[1] SHUI Yuan;LAI Longhui;MA Wentao(Department of Urology,The Second Hospital&Clinical Medical School University,Gansu 730030,China)

机构地区：[1]兰州大学第二医院(兰州大学第二临床医学院)泌尿外科,730030

出　　处：《医学研究杂志》2025年第2期110-116,共7页Journal of Medical Research

基　　金：国家自然科学基金地区科学基金资助项目(82060459)。

摘　　要：目的比较分化型膀胱尿路上皮癌(bladder urothelial carcinoma,BUC)与普通型BUC的预后情况。方法采用回顾性研究方法,选取2012年1月~2023年3月兰州大学第二医院收治的因肌层浸润性膀胱癌行根治性膀胱切除术的236例普通型BUC和40例分化型BUC患者的临床资料。采用倾向评分匹配(propensity score matching,PSM)方法减少观察性研究中的选择偏差。Kaplan-Meier法比较两组患者的总生存期(overall survival,OS)和肿瘤特异性生存期(cancer-specific survival,CSS)。使用COX比例风险模型分析分化型BUC对总死亡风险(overall mortality risk,OMR)和肿瘤特异性死亡风险(cancer-specific mortality risk,CSMR)的影响。结果随访4~134个月,中位随访时间为30.5个月。PSM前,分化型BUC和普通型BUC在总病死率(overall mortality,OM)与疾病特异性病死率(cancer-specific mortality,CSM)方面差异均有统计学意义(P值分别为0.008、0.011)。Kaplan-Meier生存曲线分析结果显示,普通型BUC的OS(P=0.020)和CSS(P=0.023)优于分化型BUC。多因素COX回归分析结果显示,与普通型BUC比较,分化型BUC的OMR增加了75%(P=0.013),CSMR增加了79%(P=0.029)。PSM后,两组的OM(P=0.217)与CSM(P=0.134)差异均无统计学意义。Kaplan-Meier生存曲线分析结果显示,普通型BUC和分化型BUC的OS(P=0.510)和CSS(P=0.340)差异均无统计学意义。多因素COX回归分析结果显示,两组的OMR和CSMR差异均无统计学意义(P均>0.05)。结论PSM后,与普通型BUC比较,分化型BUC的预后结局并不差,特殊分化类型并不是预后较差的独立预测因子。Objective To compare the prognosis of differentiated bladder urothelial carcinoma(BUC)and common BUC.Methods A retrospective study was conducted to select the clinical data of 236 patients with common BUC and 40 patients with differentiated BUC who underwent radical cystectomy for muscular invasive bladder cancer from January 2012 to March 2023 in the Second Hospital of Lanzhou University.A propensity score matching(PSM)method was used to reduce selection bias in observational studies.The Kaplan-Meier method was used to compare overall survival(OS)and disease-specific survival(CSS)between the two groups.The COX proportional risk model was used to analyze the effect of differentiated BUC on overall mortality risk(OMR)and cancer-specific mortality risk(CSMR).Results The median follow-up time was 30.5months,ranged from 4months to 134months.Before PSM,there were significant differences in overall mortality(OM)and cancer-specific mortality(CSM)between the differentiated BUC and the common BUC(P were 0.008,0.011).The Kaplan-Meier survival curve analysis showed the OS(P=0.020)and CSS(P=0.023)of common BUC were better than those of differentiated BUC.Multivariate COX regression analysis showed that the OMR and CSMR of differentiated BUC increased by 75%(P=0.013)and 79%(P=0.029)compared with common BUC.After PSM,there was no significant difference in OM(P=0.217)and CSM(P=0.134)between the two groups.Kaplan-Meier survival curve analysis showed that there was no significant difference in OS(P=0.510)and CSS(P=0.340)between common BUCand differentiated BUC.Multivariate COX regression analysis showed that there were no significant differences in OMR and CSMR between the two groups(all P>0.05).Conclusion After PSM,the prognosis of differentiated BUC was not found to be inferior to that of the common BUC.Furthermore,the specific type of differentiation was not identified as an individual predictor of a worse prognosis.

关 键 词：普通型尿路上皮癌 分化型尿路上皮癌 倾向评分匹配 生存 死亡风险 

分 类 号：R69[医药卫生—泌尿科学] R694[医药卫生—外科学]