腺性分化对PT1期膀胱尿路上皮癌复发的影响

The influence of glandular differentiation to recurrence of patients with bladder urothelial carcinoma

目的研究腺性分化对PT1期膀胱尿路上皮癌(BUC)患者复发的影响。方法回顾性分析248例PT1期BUC患者的临床资料及病理结果,其中合并腺性分化的BUC(UCGD)患者有82例记为UCGD组,没有任何组织学变异的有166例为对照组。结果与对照组相比,UCGD 组复发率明显较高(P=0.005)。单变量分析结果显示,最大肿瘤直径(HR=1.502,95%CI:1.158~1.861,P=0.029),淋巴血管侵犯(LVI)(HR=1.226,95%CI:1.013~1.945,P=0.039)以及腺性分化(HR=1.787,95%CI:1.298~2.552,P=0.001)等因素与肿瘤的复发密切相关。多变量分析结果显示,腺性分化(HR=1.871,95%CI:1.338 ~2.589,P<0.001)和LVI(HR=1.356,95%CI:1.053~2.174,P=0.042)对尿路上皮癌的复发有明显的影响。结论对于PT1期BUC患者,腺性分化与BUC的复发显著相关,所以对于合并腺性分化的患者应该引起重视,定期随访和复查,必要时进行根治性膀胱切除术。

Objective To research the influence of glandular differentiation(GD)to the recurrence of patients with bladder urothelial carcinoma(BUC)in pT1.Methods We retrospectively analyzed the pathological and clinical data of 248 patients with pT1 BUC.82 of them with glandular differentiation served as UCGD group,others without histological variants served as control group.Results Compared with the control group,the recurrence rate in UCGD group was significantly higher(P = 0.005).According to univariate analysis,the largest tumor size(HR = 1.502,95%CI:1.158~1.861,P = 0.029),lymphovascular invasion(HR = 1.226,95%CI:1.013~ 1.945,P = 0.039)and glandular differentiation(HR = 1.787,95%CI:1.298~2.552,P = 0.001)were closely related with the recurrence of the tumor.The results of multivariate analysis showed that glandular differentiation (P < 0.001)and lymphovascular invasion(P = 0.042)significantly influenced the risk of recurrence of BUC.Conclusion For patients with PT1 BUC,glandular differentiation is significantly related with the risk of recurrence.Therefore,BUC patients with glandular differentiation should be followed up and checked regularly,and take radical cystectomy if necessary.