老年男性浸润性膀胱癌患者的诊治及预后分析

Diagnosis and prognosis of muscle invasive bladder cancer in elderly male patients

目的:探讨老年男性浸润性膀胱癌患者的诊治及预后因素。方法:回顾性分析2007年1月1日至2017年12月31日于我院收治男性浸润性膀胱癌患者中年龄≥70岁的尿路上皮癌患者115例。所有患者均行根治性膀胱全切术,依据预后结局将患者分为删失组及死亡组,比较两组基线资料、治疗方法及预后情况,采用log-rank检验进行单因素分析,Cox风险比例回归模型进行多因素分析,并绘制有意义变量的生存曲线。结果:在115例患者中,48例患者术后全因死亡,决定患者预后的独立危险因素是ASA分级(HR=2.645,P=0.001)和辅助化疗(HR=2.453,P=0.005),患者的1、3、5年总生存率分别为77.9%、65.4%、45.3%。结论:根治性膀胱全切术+盆腔淋巴结清扫术是治疗老年男性浸润性膀胱癌的主要方式,年龄并不是影响患者预后生存的独立危险因素,其生存期可能与ASA分级及术后辅助化疗有关。

Objective:To investigate the diagnosis and prognosis of muscle invasive bladder cancer(MIBC)in elderly male patients.Methods:We retrospectively evaluated 115 male patients aged over 70 years old with MIBC at our center between January 1,2007 and December 31,2017.All patients underwent radical cystectomy and they were divided into the censoring group and the all cause mortality group according to the outcome of the prognosis.Patient demographics,treatment,and prognosis data were recorded.Log-rank test and multivariate Cox proportional hazards regression were used to estimate the hazard ratio and 95%confidence intervals.The Kaplan-Meier survival curve of meaningful variables was plotted.Results:Of the 115 patients,48(41.7%)patients died of all cause.The independent risk factors of prognosis were ASA(HR=2.645,P=0.001)and adjuvant chemotherapy(HR=2.453,P=0.005).The 1-,3-,and 5-year overall survival rates of patients were 77.9%,65.4%,and 45.3%,respectively.Conclusion:Radical cystectomy with pelvic lymphadenectomy is still the main method for the treatment of MIBC in elderly male patients.Age is not an independent risk factor for prognosis of patients.Survival may be associated with ASA classification and adjuvant chemotherapy.