高级别及低级别尿路上皮癌的临床病理差异及预后分析  

Clinicopathological differences and prognosis between high-grade urothelial carcinoma and low-grade urothelial carcinoma

作　　者：华浩铭 王林茹 余娜 黄岩 沈靖[1] 王红群 HUA Hao-ming;WANG Lin-ru;YU Na;HUANG Yan;SHEN Jing;WANG Hong-qun(Department of Pathology,the Third The People’s Hospital of Bengbu,Bengbu 233099,China;Department of Pathology,the Second People’s Hospital of Bengbu,Bengbu 233099,China;Department of Pathology,the First Medical Center of PLA General Hospital,Beijing 100853,China;Department of Pathology,Bengbu Hospital of Traditional Chinese Medicine,Bengbu 233000,China.)

机构地区：[1]蚌埠市第三人民医院病理科,安徽蚌埠233099 [2]蚌埠市第二人民医院病理科,安徽蚌埠233099 [3]解放军总医院第一医学中心病理科,北京100085 [4]蚌埠市中医院病理科,安徽蚌埠233000

出　　处：《诊断病理学杂志》2025年第2期145-151,共7页Chinese Journal of Diagnostic Pathology

基　　金：安徽省临床医学研究转化专项(202204295107020051)。

摘　　要：目的探讨高级别、低级别尿路上皮癌的临床病理差异,为尿路上皮癌的诊断及预后判断提供依据。方法收集197例尿路上皮癌,分析比较2组的临床病理因素差异,并分析影响预后的因素。结果发病年龄为27-89岁,中位年龄67岁。高级别组较低级别组:年龄更大;侵犯程度更深;肿瘤更大;癌栓的发生及远处转移发生率更高;发生部位也有差异(均为P<0.05)。低级别组中Ki-67均≦10%,高级别组中Ki-67多数>10%(47/48,97.9%)及影响生存(均为P<0.05),且Ki-67≧20%的患者生存时间更短(P=0.013)。CPS评分显示,PD-L1>10在高级别组中有更高的表达率(63.3%,19/30,P<0.001),且PD-L1>10组的总生存时间缩短(33.806±2.886 vs.24.378±4.381个月,P=0.023)。单因素生存分析显示影响患者总生存时间的因素:肿瘤级别,年龄,癌栓,淋巴结转移,远处转移,侵犯程度,肿瘤大小及部位。多因素COX回归分析显示远处转移、癌栓、肿瘤大小及侵犯程度是影响总生存时间的独立预后因素。结论高级别及低级别尿路上皮癌在发病年龄、肿瘤最大径、侵犯深度、发生部位、癌栓、远处转移及预后均存在差异。Ki-67及PD-L1可作为分级及预后判断的标记物。多种因素影响尿路上皮癌的预后。Objective To investigate the clinicopathological differences between high-grade and low-grade urothelial carcinoma,and to provide basis for the diagnosis and prognosis of urothelial carcinoma.Methods A total of 197 cases of urothelial carcinoma were collected,and the differences of clinicopathological factors between high-grade group and low-grade group were analyzed and compared,and the factors of affecting the prognosis were analyzed.Results The age of onset ranged from 27 to 89 years,with a median age of 67 years.The high-grade group had an older age,and greater depth of invasion than the low-grade group;the incidence of tumor thrombus and distant metastasis was higher,and the tumors were larger than those of the low-grade group;there were also differences in the location of occurrence(all P<0.05).In the low-grade group,Ki-67 indes was≦10%,while in the high-grade group,Ki-67 was mostly>10%(47/48,97.9%)(P<0.05),and the overall survival time(OS)of patients with Ki-67≧20%was shortened(P=0.013).The CPS score showed that PD-L1>10 had a higher positive expression rate in the high-grade group(63.3%,19/30,P<0.001),and the OS of PD-L1>10 group was shortened(24.378±4.381 vs.33.806±2.886 months,P=0.023).Univariate survival analysis showed that the clinicopathological factors of affecting OS were as follows:age,tumor grade,degree of invasion,tumor size,tumor thrombus,lymph node metastasis,distant metastasis and location.Multivariate Cox regression analysis showed that distant metastases,tumor thrombus,tumor size and degree of invasion were independent prognostic factors for OS.Conclusion There are many clinicopathological differences between high-grade and low-grade urothelial carcinoma,as follows,age,size,depth of invasion,location,the incidence of tumor thrombus and distant metastasis,and prognosis,etc.Ki-67 and PD-L1 can be used as a marker for grading and prognosis.Several factors influence the prognosis of urothelial carcinoma.

关 键 词：尿路上皮癌 肿瘤级别 临床病理差异 预后 Ki-67 PD-L1 

分 类 号：R737.14[医药卫生—肿瘤]