2004年和1973年世界卫生组织肿瘤分级预测局限浸润性膀胱癌复发价值的比较

Prognostic significance of the 2004 WHO classification compared with the 1973 WHO classification for organ-confined invasive bladder cancer

目的比较2004年和1973年WHO肿瘤分级预测局限浸润性（T分期≤pT2b）膀胱尿路上皮癌行根治性膀胱切除术后肿瘤复发概率的价值。方法回顾分析2000年2月至2011年8月具有完善随访结果的173例局限浸润性膀胱尿路上皮癌患者的临床及随访资料。采用Kaplan—Meier法和Log—rank检验评估无复发生存率（RFS）；Cox比例风险模型进行单因素及多因素分析评估膀胱癌各传统预后因素（肿瘤分期、分级，淋巴结状况，淋巴血管肿瘤浸润情况，术前。肾积水，是否纯尿路上皮癌）对RFS的影响。结果患者5年RFS为84．7％。Cox分析显示，采用2004年WHO分级时，淋巴结阳性（RR=4．573，95％CI：1．469—14．237）、肿瘤分级（RR=9．993，95％CI：1．325～75．390）、术前肾积水（RR=3．207，95％CI：1．209～8．508）是RFS的独立预测因素；采用1973年WHO分级时，淋巴结阳性（RR=9．484，95％CI：3．450～26．074）和淋巴血管肿瘤浸润（RR=3．009，95％CI：1．062～8．526）是RFS的独立预测因素。结论2004年WHO分级作为RFS的独立预测因素，较1973年WHO分级更适用于T2b期以下局限浸润性膀胱癌，但仍需要进一步的前瞻性研究以证实其预后预测作用。

Objective To compare the 2004 and 1973 WHO classifications for predicting tumor recurrence for organ-confined （T stage ≤ pT2b） invasive urothelial carcinoma of the bladder treated with radical cystectomy. Methods From February 2000 to August 2011, the 173 consecutive cases of organ- confined invasive urothelial carcinoma of the bladder were treated with radical cystectomy. The data of clinical and follow-up information was collected. The Kaplan-Meier plots with Log-rank test were used to estimate recurrence-free survival （ RFS ）. Univariate and multivariate analysis using the Cox proportional hazard regression model were performed to evaluate the impact of any clinicopathological prognostic factors （tumor grade, tumor stage, lymph node status, lymphovascular invasion, preoperative hydronephrosis, and non-pure urothelial carcinoma） on RFS. Results The 5-year RFS was 84. 7% for the entire cohort. Univariate and multivariate analysis demonstrated that when using the 2004 WHO classification, lymph node status （RR =4. 573, 95% CI： 1. 469-14. 237）, tumor grade （RR =9. 993, 95% CI： 1. 325-75. 390） and preoperative hydronephrosis （ RR = 3. 207, 95% CI： 1. 209-8. 508 ） presented independent predictors for RFS; while using the 1973 WHO system, lymph node status （RR = 9. 484, 95% CI： 3. 450-26. 074） and lymphovaseular invasion （RR = 3. 009, 95% CI： 1. 062-8. 526） were independent predictors. Conclusions The 2004 WHO classification, as an independent factor, is superior to the 1973 classification for predicting RFS in patients with organ-confined invasive bladder cancer treated with radical cystectomy. However, a further perspective study is needed to validate its role in prognosis.