膀胱肉瘤样癌临床疗效分析26例报告并文献复习

Clinical efficacy analysis of sarcomatoid carcinoma of the bladder:report of 26 cases and literature review

目的:探讨膀胱肉瘤样癌的临床表现、诊断、治疗及预后。方法:回顾性分析2010年6月—2018年10月我院收治的26例病理确诊为膀胱肉瘤样癌患者的临床资料,其中男18例,女8例。24例行手术治疗,其中7例行经尿道膀胱肿瘤电切术(transurethral resection for bladder tumor,TURBT),7例行膀胱部分切除术,10例行根治性膀胱切除术;余2例未行手术治疗。采用Kaplan-Meier法进行生存分析。结果:术后病理TNM分期:T1N0M0期7例,T2N0M0期7例,T3N0M0期8例,T3N2M0期2例,T4NxM0期1例,T4NxM1期1例。根据浸润深度分类:7例为非肌层浸润肿瘤,19例为肌层浸润肿瘤。24例获得随访,2例失访,随访时间280个月,中位随访时间为14个月,死亡病例19例,中位随访时间13个月。生存分析显示不同浸润深度及手术方式预后之间差异有统计学意义。结论:膀胱肉瘤样癌是一种罕见的高度恶性肿瘤,预后相对较差。非肌层浸润肿瘤行TURBT术可取得相对较好的预后。肿瘤分期是影响预后最重要的因素,因此早发现、早治疗是改善其预后的重要条件。

Objective: To investigate the clinical manifestations, diagnosis, treatment and prognosis of sarcomatoid carcinoma of the bladder. Methods: An analysis of the clinical data of 26 patients with pathologically confirmed bladder sarcomatoid carcinoma admitted to our hospital from June 2010 to October 2018 was taken, including 18 males and 8 females. Twenty-four cases underwent surgical treatment, 7 transurethral resections for bladder tumor, 7 partial cystectomies, and 10 radical cystectomies. The remaining 2 cases did not receive surgical treatment. The Kaplan-Meier method was used for survival analysis. Results: Postoperative pathological TNM staging showed 7 cases of T1N0M0stage, 7 cases of T2N0M0stage, 8 cases of T3N0M0stage, 2 cases of T3N2M0stage, 1 case of T4NxM0stage, 1 case of T4NxM1stage. According to the depth of invasion: 7 cases were non-muscular invasive tumors, 19 cases were muscular infiltrating tumors. All cases except 2 were followed up, and the follow-up period was 2-80(median, 14) months. Nineteen cases died, and the median follow-up period was 13 months. Survival analysis showed that there was statistically significant difference in the prognosis among different infiltration depths and surgical methods. Conclusion: Bladder sarcomatoid carcinoma is a rare and highly malignant tumor with a relatively poor prognosis. TURBT for non-muscular invasive tumors can achieve a relatively good prognosis. Tumor staging is the most important factor affecting the prognosis, so early detection and early treatment are important for improving the prognosis.