伴鳞状分化的膀胱高级别尿路上皮癌的临床特点

The clinical characteristics of high-grade urothelial carcinoma with squamous differentiation

目的比较伴鳞状分化的膀胱高级别尿路上皮癌与单纯膀胱高级别尿路上皮癌在病理分期及预后上的差异。方法我们回顾性分析了从2005年1月至2014年12月的64位接受膀胱根治性切除术的高级别尿路上皮癌患者,其中20例伴有鳞状分化。两组间的病理分期差异采用Fisher精确检验。相关生存期生存分析采用Kaplan-Meier法,Log-rank检验用来比较两组间的差异。结果伴鳞状分化组占31%(20例),其中pT1期4例,pT2期4例,pT3期10例,pT4期2例。对照组(非鳞状分化组)44例,其中T1期13例,T2期21例,T3期6例,T4期4例。两组间在病理分期上存在着差异(P<0.05),其中伴鳞状分化组T3或T4期占60.0%,显著高于对照组(22.7%)。伴鳞状分化组与对照组的3年总体生存率分别为44.1%和77.3%(P<0.05),3年无复发生存率分别为29.7%和74.5%(P<0.05)。结论伴鳞状分化的高级别尿路上皮癌与单纯高级别尿路上皮癌相比,具有更高的病理分期,更强的浸润性,肿瘤总体生存率较差,复发率较高。

Objective To explore the differences of pathological stage and prognostic value between high-grade urothelial carcinoma with and without squamous differentiation.Methods We retrospectively reviewed the records of 64 patients treated with radical cystectomy between Jan.2005 and Dec.2014.Differences of pathological stages between cases with and without squamous differentiation were assessed by Fisher tests.Kaplan-Meier method was used to evaluate survival curves,and logrank test was adopted to assess the statistical significance.Results Squamous differentiation was observed in20（31%）of the 64 patients,including 4 pT1,4 pT2,10 pT3 and 2 pT4.The control group consisted of 44 cases,including 13 pT1,21 pT2,6pT3 and 4 pT4.There was significant difference in pathological stage between patients with and without squamous differentiation（P〈0.05）.The number of pT3 and pT4 in squamous differentiation group accounted for 60%,which was higher than that of the control group（22.7%）.The 3-year survival rate and 3-year recurrence-free rate of patients with squamous differentiation were 44.1% and 29.7%,while those of the control were 77.3% and 74.5%（log-rank test,P〈0.05）.ConclusionsHigh-grade urothelial carcinoma with squamous differentiation,compared with pure high-grade urothelial carcinoma,has a higher pathological stage and is more invasive.Moreover,the overall survival of cases with squamous differentiation is poorer,and the progression is faster.Further studies with a larger number of patients are necessary to confirm these results.