腺性分化对PT1期膀胱尿路上皮癌患者预后的影响

Effects of glandular differentiation to the prognosis of patients with bladder urothelial carcinoma in PT1

目的探讨腺性分化(glandular differentiation,GD)对PT1期膀胱尿路上皮癌(bladder urothelial carcinoma,BUC)患者预后的影响。方法对248例PT1 BUC患者分组,其中UCGD组为合并腺性分化者82例,对照组为单纯的BUC患者(不合并任何组织学变异)166例。回顾性分析其病理结果及临床资料。结果UCGD组预后明显差于对照组(P=0.007)。在单变量分析中,淋巴血管侵犯(HR 1.416,95%CI 1.120~2.254,P=0.013)和腺性分化(HR 1.367,95%CI 1.115~1.853,P=0.038)与BUC患者的预后明显相关;在多变量分析中,同样显示腺性分化(HR 1.462,95%CI 1.138~2.393,P=0.007)和淋巴血管侵犯(HR 1.348,95%CI 1.052~1.944,P=0.022)是与患者预后相关的独立因素。结论合并腺性分化PT1 BUC患者预后差,术后应定期进行跟踪随访和复查,如果有必要应该进行根治性膀胱切除术。

Objective To explore the effects of glandular differentiation(GD)on the prognosis of bladder urothelial carcinoma(BUC)in pT1.Methods We retrospectively analyzed the clinical and pathological data of 248 BUC patients in pT1,82 of them with glandular differentiation as UCGD group and the other 166 patients with pure BUC but without histological variants as control group.Results The prognosis was significantly worse in UCGD group than in the control group(P=0.007).In univariate analysis,lymphovascular invasion(HR 1.416,95%CI 1.120-2.254,P=0.013)and glandular differentiation(HR 1.367,95%CI 1.115-1.853,P=0.038)were significantly related to the prognosis of the patients.In multivariate analysis,glandular differentiation(HR 1.462,95%CI 1.138-2.393,P=0.007)and lymphovascular invasion(HR 1.348,95%CI 1.052-1.944,P=0.022)were independent factors related to the prognosis of PT1 BUC patients.Conclusion The prognosis of PT1 UCGD patients is significantly worse than that of pure PT1 BUC patients.Therefore,UCGD patients should be regularly followed up and reviewed after the operation and should receive radical cystectomy if necessary.