尿路上皮癌伴鳞状分化对TURBT术后pT1期患者预后的影响

Influence of squamous differentiation on the prognosis of patients with pT1 urothelial carcinoma of bladder after TURBT

目的:探讨尿路上皮癌伴鳞状分化对初次经尿道膀胱肿瘤电切术(TURBT)术后p T1期患者预后的影响。方法:回顾性分析初次经TURBT手术、术后病理诊断为T1期的531例膀胱尿路上皮癌患者的临床病理资料。根据患者的术后病理诊断将患者分为2组:A组为尿路上皮癌(单纯型)441例,B组为尿路上皮癌伴鳞状分化90例,应用SPSS 20.0统计软件,运用KaplanMeier法分析两种临床病理特点对无复发生存期(RFS)和无进展生存期(PFS)的影响,并用Log-rank检验比较生存曲线;运用COX回归模型单因素和多因素分析膀胱尿路上皮癌伴鳞状分化与初次TURBT术后p T1期患者预后之间的关系,评估影响其RFS和PFS的因素。结果:A组单纯尿路上皮癌441例(83.05%),B组尿路上皮癌伴鳞状分化90例(16.95%)。B组与A组比较更易具有高级别肿瘤(P<0.001),同时B组较A组有较高的复发率(P=0.018)、较短的无复发生存期(P<0.001)以及较高的进展率(P=0.001)、较短的无进展生存期(P<0.001)。B组与A组比较,年龄(P=0.185)、性别(P=0.135)、吸烟(P=0.728)、肿瘤大小(P=0.436)、肿瘤数目(P=0.112)和膀胱灌注(P=0.054)等差异均无统计学意义。COX多因素生存分析显示:吸烟(HR 1.34,95%CI 1.00-1.79,P=0.048)、鳞状分化的伴发情况(HR 1.43,95%CI 1.02-2.00,P=0.040)以及病理分级(HR 1.51,95%CI 1.13-2.01,P=0.005)等因素显著增加TURBT术后p T1期患者的复发风险;同时,吸烟(HR 1.80,95%CI 1.17-2.76,P=0.008)、鳞状分化的伴发情况(HR 2.07,95%CI 1.32-3.24,P=0.001)以及病理分级(HR 1.90,95%CI 1.24-2.92,P=0.003)等因素显著增加TURBT术后p T1期患者的进展风险。结论:尿路上皮癌伴鳞状分化是TURBT术后p T1期患者的预后独立影响因素,复发率及进展率较高,需密切随访。

Objective： To evaluate squamous differentiation on prognosis in patients with p T1 urothelial carcinoma of bladder（UCB） after first transurethral resection（TURBT）. Methods： The retrospective study based on clinicopathologic data was applied to 531 patients of p Tl UCB after first TURBT. The patients were divided into two groups：group A included 441 patients with pure UCB, and group B included 90 patients with squamous differentiation. All the data were calculated by using SPSS 20.0 statistical software（IBM Company, version20.0）.Recurrence-free survival（RFS） and progression-free survival（PFS） curves were estimated to study clinicopathologic features of two groups using the Kaplan-Meier method, and the difference was determined by the log-rank test. Univariate and multivariate analyses were performed to study patient prognosis between patients with squamous differentiation and patients with p T1 UCB through using a Cox proportional hazards regression model, and the factors influencing its RFS and PFS were evaluated. Results： In this study, group A included441 patients with pure UCB, and group B included 90 patients with squamous differentiation. High grade tumors were more common in patients with squamous differentiation than those with pure UCB（P〈0.001）. Meanwhile, compared with group A, group B had a higher recurrence rate（P =0.018）, shorter RFS（P〈0.001）, and the progress of the higher rate（P=0.001）, shorter PFS（P〈0.001）. Correlations among the age（P=0.185）, gender（P=0.135）, smoking（P=0.728）, tumor size（P=0.436）, and tumor count（P=0.112） were not statistically significant. Based on multivariate Cox regression analysis, smoking（HR 1.34, 95% CI 1.00-1.79, P =0.048）, comorbid conditions of squamous differentiation（HR 1.43, 95% CI 1.02-2.00, P =0.040） and pathology classification（HR 1.51, 95% CI 1.13-2.01, P = 0.005） in patients with p T1 urothelial carcinoma of bladder after first TURBT had a higher risk of recurrence; smoking（HR 1.80, 95% CI 1.17-2.76,P =0.008）, comorbid conditions of squamous differentiation（HR 2.07, 95% CI 1.32-3.24, P = 0.001） and pathology classification（HR 1.90,95% CI 1.24-2.92, P =0.003） in patients with p T1 urothelial carcinoma of bladder after first TURBT had a higher risk of progress.Conclusion： UCB with squamous differentiation is an independent prognostic predictor, and the presence of squamous differentiation could be associated with higher recurrence/progress rate, and patients with this variant should be followed up closely.