原发T1G3膀胱尿路上皮癌病理亚分期与预后的关系

Relationship between sub-stage of initial high-grade T1 bladder urothelial carcinoma and prognosis

目的：探讨病理亚分期在T1G3膀胱尿路上皮癌患者预后评价中的意义以及T1me（T1-微浸润和T1-广泛浸润）亚分期系统作为T1G3患者亚分期方法的可行性。方法选择原发T1G3膀胱尿路上皮癌患者87例，其中56例患者的基础资料、病理阅片及随访完整。按照T1me分期法，将56例T1G3膀胱尿路上皮癌患者经尿道膀胱肿瘤电切术后获得的病理标本分为T1m期17例（A组）和T1e期39例（B组），然后分析患者的预后情况。基础资料比较采用χ2检验，5年无复发生存率、5年无进展生存率比较采用Kaplan-Meier生存分析及Log-rank检验。结果两组患者年龄、肿瘤大小、是否多发、膀胱灌注治疗等方面比较差异均无统计学意义（P＞0．05）。5年无复发生存率（P＝0．037）、5年无进展生存率（P＝0．045）比较差异均有统计学意义，T1m期患者预后优于T1e期患者。结论病理亚分期是判断原发T1G3膀胱尿路上皮癌患者预后的重要因素。T1me分期法作为T1G3膀胱尿路上皮癌病理亚分期的分期方法客观、实用、易行。

Objective To evaluate the impact of sub-stage on the clinical prognosis of T 1 G3 and evaluate the feasibility of the T1me system in pT1G3 sub-staging.Methods The clinical data,pathological specimen and follow-up data were collected from 56 patients out of 87 patients diagnosed with initial high-grade T1 bladder urothelial carcinoma .The patients were divided into Group A [ T1-microinvasive （T1m）,17 cases] and group B [T1-extensive-invasive （T1e）,39 cases] according to pathological evaluation after transurethral resection.Clinical parameters were analyzed with Chi-square test,and recurrence-free and progression free survival were obtained by Kaplan-Meier analysis and Log-rank test.Results Age,tumor size,number and intravesical instilled medication showed no significant differences between the 2 groups （ P〉0.05 ） .There were significant differences of 5-year recurrence-free rate （ P =0.037 ） and progression-free survival rate （ P =0.045 ） between the 2 groups, and the prognosis of group A was significantly better than that of group B .Conclusion The pathological sub-stage is an important predictor in initial high-grade T1 bladder urothelial carcinoma patients , and the T1me system is objective and feasible.