脐尿管癌的临床特征及预后相关因素分析

Analysis of clinical features and prognostic factors of urachal carcinoma

目的探讨脐尿管癌的临床特征及预后影响因素。方法回顾性分析2011年8月至2019年11月郑州大学第一附属医院收治的35例脐尿管癌患者的临床资料。男23例,女12例,男女比例为1.92∶1。平均年龄(52.1±13.9)岁,中位年龄55岁。有吸烟史8例,饮酒史3例。合并高血压病5例,糖尿病5例,冠心病2例,脑梗死1例。首发症状表现为血尿25例,下腹部疼痛4例,腹部包块2例,脐部流脓1例,无症状者4例。术前CT检查示肿瘤位于膀胱顶壁24例,膀胱前壁11例。肿瘤呈实性25例,囊性10例。中位肿瘤最大径4.0(1.5~11.0)cm。35例术前膀胱镜检查均发现膀胱前壁或顶壁肿物。35例术前诊断均不除外脐尿管癌。35例均行扩大的膀胱部分切除术(常规切除脐部),3例同期行盆腔淋巴结清扫术。其中开放手术19例,腹腔镜手术14例,达芬奇机器人辅助腹腔镜手术2例。结果本组35例术后Mayo分期为Ⅰ期10例,Ⅱ期18例,Ⅲ期1例,Ⅳ期6例。总体随访率91.4%(32/35),中位随访时间41(3~103)个月。1、3、5年生存率分别为82.5%、59.3%、53.9%。单因素分析结果显示,年龄(P=0.033)、肿瘤最大径(P=0.011)、淋巴结转移(P=0.002)、远处转移(P=0.011)、病理分级(P=0.001)、Mayo分期(P=0.026)是预后相关影响因素。Cox多因素分析结果显示,病理分级低分化(HR=1.640,95%CI 1.112~2.418,P=0.013)、肿瘤最大径≥4 cm(HR=5.000,95%CI 1.099~22.755,P=0.037)是影响患者预后的独立因素。结论脐尿管癌是一种发病隐匿的膀胱恶性肿瘤,初诊症状多为血尿,确诊时多已处于临床分级中晚期,预后较差。病理分级和肿瘤最大径是影响脐尿管癌患者预后的独立因素,病理分级越高、肿瘤最大径越大,预后越差。

Objective To explore the clinical features and prognosis of urachal carcinoma.Methods The clinical data of 35 patients with urachal carcinoma admitted to the First Affiliated Hospital of Zhengzhou University from August 2011 to November 2019 were analyzed retrospectively.There were 23 males and 12 females,with a male to female ratio of 1.92∶1.The average age was(52.1±13.9)years old,and the median age was 55 years old.There were 8 patients with a history of smoking and 3 patients with a history of drinking.There were 5 cases of hypertension,5 cases of diabetes,2 cases of coronary heart disease,and 1 case of cerebral infarction.The first symptoms were hematuria in 25 cases,lower abdominal pain in 4 cases,abdominal mass in 2 cases,umbilical discharge in 1 case,and asymptomatic in 4 cases.Preoperative CT examination showed that the tumor was located on the top wall of the bladder in 24 cases and the front wall of the bladder in 11 cases.There were 25 solid tumors and 10 cystic tumors.The maximum diameter of the tumor was 1.5 to 11.0 cm,and the median maximum diameter of the tumor was 4.0 cm.Preoperative cystoscopy detected masses on the anterior or top wall of the bladder and urachal carcinoma was suspected in 35 cases.All 35 cases underwent enlarged partial cystectomy(conventional resection of the umbilical part),and 3 cases underwent pelvic lymph node dissection at the same time.Among them,19 cases underwent open surgery,14 cases underwent laparoscopic surgery,and 2 cases underwent Da Vinci robot assisted laparoscopic surgery.Results According to Mayo staging,there were 10 cases of stageⅠ,18 cases of stageⅡ,1 case of stageⅢ,and 6 cases of stageⅣ.The overall follow-up rate was 91.4%(32/35),and the median follow-up time was 41(3-103)months.The 1-year survival rate was 82.5%,the 3-year survival rate was 59.3%,and the 5-year survival rate was 53.9%.Univariate analysis showed that age(P=0.033),maximum tumor diameter(P=0.011),lymph node metastasis(P=0.002),distant metastasis(P=0.011),pathological grade(P=0.001),Mayo staging(P=0.026)were ralated prognostic factors(all P<0.05).Cox multivariate analysis showed that the pathologically poor differentiation(HR=1.640,95%CI 1.112-2.418,P=0.013),and the largest tumor diameter≥4cm were(HR=5.000,95%CI 1.099-22.755,P=0.037).Independent factors affecting patient prognosis.Conclusions Urachal carcinoma is a malignant bladder tumor with insidient onset.Most of the first diagnosis symptoms are hematuria.When diagnosed,most patients are in the middle and late stages of clinical grading,and the prognosis is poor.Pathological grade and maximum tumor diameter are independent factors that affect the prognosis of patients with urachal carcinoma.The higher was the pathological grade,and the larger was the maximum tumor diameter,the worse was the prognosis.