根治性膀胱全切术后患者临床病理及预后的性别差异(附427例报告)

Gender-related differences in clinicopathologic and prognosis outcomes following radical cystectomy for bladder cancer:report of 427 cases

目的:探讨根治性膀胱全切术后患者临床病理及预后的性别差异。方法:回顾性分析427例根治性膀胱全切患者的临床病理资料并行院外随访,通过单因素分析,比较膀胱癌临床及病理特点的性别差异,通过Kaplan-Meier生存分析法及单因素、多因素Cox回归分析,探讨膀胱癌长期预后的差异。结果:本组男361例,女66例,男女发病人数之比约为5.5∶1。入组患者中,男性吸烟比例更高(P<0.001),女性化学物品接触比例更高(P=0.018)。与男性相比,女性患者更易出现较低的肿瘤分期(P=0.003);手术过程中,女性患者较男性出血少(P=0.018),手术时间短(P=0.005),更倾向选择非可控的尿流改道方式(P<0.001)。Kaplan-Meier生存分析显示两组整体总生存率(P=0.894)、肿瘤特异性生存率差异(P=0.735)无统计学意义。结论:女性膀胱全切术后膀胱癌患者更易出现较低的肿瘤分期,倾向选择非可控的尿流改道方式,但患者整体长期预后无显著性别差异。

Objective：To assess the gender-related differences in clinicopathologic and prognosis outcomes following radical cystectomy for bladder cancer.Method：A retrospective review of 427 patients with bladder cancer following radical cystectomy was performed.We reviewed clinicopathologic data from these patients and used univariate analysis to determine the gender-related differences.The Kaplan-Meier method,with the log-rank test and cox regression analysis were adopted to investigate the gender differences of long-term prognosis of patients.Result：In the 427patients（361men,66women）who were examined,the male-to-female bladder cancer incidence ratio was 5.5∶1.Males were more likely to smoke and females tended to be exposed to chemicals.Compared to males,female patients in our cohort had higher rates of lower pathologic stage disease（P=0.003）.They had lower blood loss（P=0.018）,shorter length of stay（P=0.005）and were less likely to undergo continent diversion（P〈0.001）.Generally,no difference in overall survival rate（log-rank,P=0.894）or cancer specific survival rate（log-rank,P=0.735）was observed between the sexes.Conclusions：Female patients in our cohort had significantly higher rates of lower pathologic stage disease and are less likely to undergo continent diversion.But the gender difference of long-term prognosis of patients with bladder cancer after radical cystectomy is not significant.