浸润性膀胱癌根治术预后影响因素的研究

Study on the prognostic factors of patients with invasive bladder cancer after radical surgery

目的探讨影响浸润性膀胱癌患者根治术后长期生存的预后因素。方法回顾性分析1991-2004年178例浸润性膀胱癌患者资料,选择12个对预后可能产生影响的因素及尿流改道方式、新辅助化疗等特征性因素进行Cox回归分析。计算患者的预后指数(PI),将患者分组计算不同个体的期望生存曲线。结果影响浸润性膀胱癌患者长期生存的因素分别为分期(RR=1．982,P=0．000)、分级(RR=1．978,P=0．042)、淋巴结转移(RR=2．142,P=0．048)、原位癌(RR=6．177,P=0．000)、肿瘤形状(RR=0．416,P=0．003)、病理类型(RR=2．228,P=0．032)、肿瘤数目(RR= 1．820,P=0．035)、患者年龄(RR=0．672,P=0．025)及新辅助化疗(RR=0．257,P=0．016)。根据预后指数的百分位数将患者分为低危组、中危组和高危组3个预后组,3组患者中位生存时间分别为42．5、22．5、7．0个月,3组患者预后两两比较差异有统计学意义(P＜0．01)。结论新辅助化疗、分期、分级、淋巴结转移、原位癌、肿瘤形状、病理类型、肿瘤数目、患者年龄是影响浸润性膀胱癌患者生存期的预后因素,PI值可用于预测浸润性膀胱癌患者的预后。

Objective To investigate the prognostic factors affecting the postoperative survival of patients with invasive bladder cancer,and to predict the survival time of the patients. Methods We retrospectively analyzed the clinical and follow-up data of 178 patients with invasive bladder cancer treated by radical cystectomy and urinary diversion from 1991 to 2004. A multivariate analysis was performed in these patients by the Cox proportional hazard model. A prognostic index （PI） based on the Cox regression was constructed. According to the individualized PI,the patients were classified into different hazard groups and the expected survival curve of each patient was calculated. Results Cox regression analysis showed that the factors which influenced the postoperative survival included tumor stage （ RR = 1. 982, P = 0. 000） , grade （RR=1.978,P =0.042）,lymph node metastasis （RR =2. 142,P =0.048）,Tis （RR =6. 177,P = 0. 000 ）, tumor shape （ RR = 0. 416, P = 0. 003 ）, number of tumors （ RR = 1. 820, P = 0. 035 ）, pathological type （ RR = 2. 228, P = 0. 032）, patient age （ RR = 0. 672, P = 0. 025 ） and neoadjuvant chemotherapy （ RR = 0. 257 ,P = 0. 016 ）. Based on the percentile of PI, patients were classified into 3 prognostic groups ; the median survival time of 3 groups were 42.5,22.5 and 7.0 months, respectively. There were significant differences between each 2 among the 3 groups （P 〈 0.01 ）. Conclusions Neoadjuvant chemotherapy, tumor stage,grade, lymph node metastasis, Tis, shape and number of tumors, pathological type, patient age were important prognostic factors. PI value can be used to predict the prognosis of patients with invasive bladder cancer.