年龄对膀胱癌根治术的影响及预后分析

The influence of age factor upon the patients with radical cystectomy and prognosis analysis

背景与目的:影响膀胱癌根治术预后的因素有许多,其中年龄是否是一项重要的预后指标,高龄患者是否应选择膀胱癌根治术,目前国内外尚存在争论。本文旨在研究年龄因素对于这行膀胱癌根治术患者的影响,进而探讨对高龄患者行根治术的意义。方法:回顾性分析行膀胱癌根治术后获得完整随访的121例患者的资料,对年龄与患者临床病理相关预后因素进行统计学分析。结果:行膀胱癌根治术高龄组患者(≥70岁)围手术期死亡的风险较其他年龄组(≤50岁或50～69岁)高,但术后早期并发症无明显差异。肌层浸润性尿路上皮癌患者随着年龄的升高,肿瘤特异性生存率(cancer specific survival,CSS)降低;非肌层浸润性尿路上皮癌患者,高龄组和其他年龄组的CSS无明显差异。多因素分析和相关性分析显示,年龄与肿瘤分期、病理分级、肿瘤大小、淋巴结转移和是否伴有淋巴血管侵犯均相关(P<0.05)。结论:高龄患者行膀胱癌根治术是安全的,在提高生存率的同时,并没有增加术后早期并发症。年龄是膀胱癌根治术患者重要的预后因素,但并不对患者预后起决定作用。起决定作用的是与年龄相关的肿瘤病理分期、分级及其它预后不良因素。

Background and purpose： There are many prognostic factors on survival for the patients with radical cystectomy, whether age is an important factor or not, or should the elderly accept the operation are still in controversy. In this article we investigated the influence of age factor upon the patients with radical cystectomy, further to evaluate the usefulness of radical cystectomy for bladder cancer in elderly patients. Methods： We retrospectively analyzed the clinical and follow-up data of 121 patients with bladder cancer treated by radical cystectomy, analyzed the effects of age and other clinical or pathological characteristics for prognosis of the patients. Results： After radical cystectomy, the perioperative mortality of the elder group （ ≥ 70 years） is higher than those of the younger group （ ≤ 50 years or between 50 to 69 years）, but there was no difference in terms of early postoperative complications among these groups. With the increase of age, the cancer specific survival of the patients with invasive bladder cancer was decreased, while for the patients with noninvasive bladder cancer, there was no difference. Multivariate and correlation analyses were performed and showed that there was close correlation between age and tumor stage, grade, size, lymph node metastasis and lymphovascular invasion. Conclusion： The treatment for the elder patients with bladder cancer by radical cystectomy is safe, the surgery could improve the survival rate of patients without increasing the postoperative complications. Age is an important prognostic factor but is not the most important. Tumor stage, grade and other poor prognosis factors play decisive roles.