膀胱腺癌国内单中心177例临床预后分析及其与SEER数据库的比较  

Clinical prognosis analysis of 177 cases bladder adenocarcinoma in a single center in China and comparison with SEER database

作　　者：张天祥 张璐 杨国良[1] 张连华[1] 曹明[1] 金迪[1] 张瑞赟 庄光磊 黄翼然[1] 薛蔚[1] 陈海戈[1] Zhang Tianxiang;Zhang Lu;Yang Guoliang;Zhang Lianhua;Cao Ming;Jin Di;Zhang Ruiyun;Zhuang Guanglei;Huang Yiran;Xue Wei;Chen Haige(Department of Urology,Renji Hospital,Shanghai Jiaotong University,School of Medicine,Shanghai 200127,China;State Key Laboratory of Systems Medicine for Cancer,Shanghai Cancer Institute,Renji Hospital,Shanghai Jiaotong University,School of Medicine,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 [2]上海交通大学医学院附属仁济医院、上海市肿瘤研究所肿瘤系统医学全国重点实验室,上海200127

出　　处：《中华泌尿外科杂志》2025年第3期166-172,共7页Chinese Journal of Urology

摘　　要：目的探索膀胱腺癌的临床病理特征、预后影响因素及其治疗疗效。方法收集2003年3月至2023年12月上海交通大学医学院附属仁济医院收治的177例膀胱腺癌患者的临床资料(仁济队列),以及2000-2021年SEER数据库中2687例膀胱腺癌患者的临床资料(SEER队列),对比两队列临床病理及预后特征。纳入的膀胱腺癌患者包括脐尿管腺癌和膀胱原发腺癌,除外原发位置位于其他部位的转移性膀胱腺癌、膀胱尿路上皮癌伴腺癌成分者。两组计数资料的比较采用χ^(2)检验;使用倾向性评分按照1∶1的比例匹配仁济队列与SEER队列的基线资料。采用Kaplan-Meier法绘制生存曲线,组间比较采用log-rank检验。使用survival R包进行单因素及多因素Cox比例风险回归分析。结果仁济队列中膀胱腺癌分期局限的患者比例高于SEER队列[61.0%(108/177)与19.4%(521/2687),P<0.001],黏液腺癌患者比例高于SEER队列[33.3%(59/177)与22.6%(607/2687),P<0.001]。在确保SEER分期、病理分级等基线资料匹配后,生存分析结果显示仁济队列膀胱腺癌患者中位生存期略高于SEER队列[55.4(24.1,196.2)个月与39.2(13.6,137.4)个月,P=0.033]。多因素Cox回归分析结果表明,仁济队列中SEER分期[HR=3.83(95%CI 1.62~9.07),P=0.002]和病理分级[HR=2.76(95%CI 1.54~4.95),P=0.001]均为膀胱腺癌患者预后的独立危险因素;SEER队列中SEER分期[HR=3.67(95%CI 3.13~4.31),P<0.001]和病理分级[HR=1.46(95%CI 1.29~1.65),P<0.001]也均为膀胱腺癌预后的独立危险因素。仁济队列中,辅助化疗患者与未辅助化疗患者的中位无进展生存期[40.1(19.5,91.6)个月与40.9(12.8,未到达)个月,P=0.976]和总生存期[79.3(37.1,195.8)个月与53.9(16.4,129.5)个月,P=0.374]差异均无统计学意义。进一步在淋巴结阳性患者中分析,辅助化疗患者较未辅助化疗患者的中位无进展生存期[40.1(38.2,75.4)个月与12.2(3.1,12.2)个月,P=0.004]和中位总生存期[68.2(46.2,84.5)个月�Objective To investigate the clinical and pathological characteristics,prognostic factors,and treatment outcomes of bladder adenocarcinoma.Methods The data of 177 bladder adenocarcinoma patients treated at Renji Hospital,Shanghai Jiaotong University School of Medicine from January 2003 to December 2023,and 2687 bladder adenocarcinoma patients from the SEER database(2000—2021)were reviewed retrospectively.The clinicopathological and prognostic characteristics were compared between the two cohorts.Patients with urachal adenocarcinoma or primary bladder adenocarcinoma were included,while metastatic bladder adenocarcinoma from other sites and urothelial carcinoma with glandular components were excluded.The Chi-square test was used for comparison of categorical data,and propensity score matching(1∶1)was applied to match baseline data between the Renji and SEER cohorts.Kaplan-Meier survival curves were generated,and log-rank tests were used for comparisons.Univariate and multivariate Cox regression analyses were performed using the survival R package,with P-values calculated via Wald tests.ResultsThe proportion of localized bladder adenocarcinoma was significantly higher in the Renji cohort than in the SEER cohort[61.0%(108/177)vs.19.4%(521/2687),P<0.001],and mucinous adenocarcinoma was more common in Renji cohort[33.3%(59/177)vs.22.6%(607/2687),P<0.001].After matching for baseline factors,including SEER stage and pathological grade,survival analysis revealed that the Renji cohort patients had slightly better survival compared to the SEER cohort[median survival:55.4(24.1,196.2)months vs.39.2(13.6,137.4)months,P=0.033].Multivariate Cox analysis identified SEER stage[Renji cohort:HR=3.83(95%CI 1.62-9.07),P=0.002;SEER cohort:HR=3.67(95%CI 3.13-4.31),P<0.001]and pathological grade[Renji cohort:HR=2.76(95%CI 1.54-4.95),P=0.001;SEER cohort:HR=1.46(95%CI 1.29-1.65),P<0.001]as independent prognostic factors.In the Renji cohort,no significant differences were observed in the median progression-free survival[40.1(19.5,91.6)m

关 键 词：膀胱肿瘤 腺癌 临床病理特征 预后因素 辅助化疗 

分 类 号：R737.14[医药卫生—肿瘤]