基于倾向性评分匹配法的非单纯尿路上皮型膀胱癌行机器人辅助下根治性膀胱切除术后生存分析

Survival outcomes of bladder cancer with non-pure urothelium:a propensity score matching analysis

目的分析比较非单纯尿路上皮型(n-pU)与单纯尿路上皮型(pU)膀胱癌患者行机器人辅助腹腔镜下根治性膀胱切除术(RARC)后的生存差异。方法回顾性收集2014年10月—2022年3月在南京大学医学院附属鼓楼医院泌尿外科行RARC的膀胱癌患者资料,依据病理学差异,分别纳入n-pU与pU膀胱癌组。经倾向性评分匹配(PSM)平衡基线资料差异后,采用Kaplan-Meier和Log-rank法绘制并比较总体生存(OS)曲线及无复发生存(RFS)曲线。应用Cox模型进行单因素和多因素分析,明确预后影响因素,并基于此进行二次分组,比较亚组间生存差异。结果经PSM后,共得到53对匹配患者,两组患者基线差异无统计学意义(P<0.05)。不考虑T分期时,两组患者在OS和RFS上的差异均无统计学意义(P=0.217、P=0.109)。肿瘤是否突破膀胱(>T2期)是OS及RFS的危险因素(P<0.05)。在肿瘤局限于膀胱内时(≤T2期),接受RARC治疗的两组患者在OS及RFS差异无统计学意义(P=0.565、P=0.344)。当肿瘤突破膀胱侵犯周围组织时(>T2期),n-pU膀胱癌患者的OS、RFS显著短于相同病理状态的pU膀胱癌患者(P=0.025、P=0.034)。结论n-pU膀胱癌患者RARC术后生存情况与病理状态显著相关,当肿瘤突破膀胱时(>T2期),其预后相较于相同病理状态下的pU膀胱癌患者更差。

Objective To compare the survival outcomes of bladder cancer with non-pure urothelium(BCa with n-pU)and bladder cancer with pure urothelium(BCa with pU)treated with robot-assisted radical cystectomy(RARC).Methods Clinical data of BCa patients treated with RARC in Nanjing Drum Tower Hospital during Oct.2014 and Mar.2022 were retrospectively analyzed.The patients were divided into n-pU group and pU group.After the baseline differences between groups were balanced with propensity score matching(PSM),the overall survival(OS)and recurrence-free survival(RFS)curve were plotted using Kaplan-Meier method and compared using Log-rank test.Univariate and multivariate analysis were performed with Cox model to identify the influencing factors of prognosis.Based on the results,a secondary grouping was performed to compare the survival differences between subgroups and further investigate the prognostic factors.Results After PSM,there were 53 pairs of BCa patients.There were no significant differences in the baseline data between the pU and n-pU groups(P<0.05).Regardless of T stage,there were no significant differences in OS and RFS between the two groups(P=0.217,P=0.109).Univariate Cox regression analysis showed that T stage(>T2)was a significant risk factor of OS and RFS(P<0.05).In the early pathological stage(≤T2),there were no significant differences in OS and RFS(P=0.565,P=0.344).In the advanced pathological stage(>T2),the OS and RFS of n-pU were significantly worse than those of pU patients(P=0.025,P=0.034).Conclusion The prognosis of BCa patients with n-pU who received RARC is significantly correlated with pathological status.At>T2 stage,n-pU patients have worse prognosis than pU patients in the same pathological status.