诊断学理论与实践 ›› 2023, Vol. 22 ›› Issue (03): 292-299.doi: 10.16150/j.1671-2870.2023.03.13
周晓蝶1a, 陈巍魏1b, 余波1a, 王璇1a, 王建军2, 石群立1a, 饶秋1a, 鲍炜1a()
收稿日期:
2023-02-14
出版日期:
2023-06-25
发布日期:
2023-11-17
通讯作者:
鲍炜 E-mail: 基金资助:
ZHOU Xiaodie1a, CHEN Weiwei1b, YU Bo1a, WANG Xuan1a, WANG Jianjun2, SHI Qunli1a, RAO Qiu1a, BAO Wei1a()
Received:
2023-02-14
Online:
2023-06-25
Published:
2023-11-17
摘要:
目的:探讨膀胱尿路上皮癌(urinary bladder urothelial carcinoma, UBUC)及上尿路上皮癌(upper tract urothelial carcinoma, UTUC)患者的临床病理特征,并分析预后。方法:随机选取2017年5月至2020年2月东部战区总医院及南京大学医学院附属鼓楼医院收治的115例尿路上皮癌(urothelial carcinoma, UC)患者,其中UBUC 80例,UTUC 35例。回顾性分析其临床资料,利用χ2检验和Fisher精确检验分析两者的临床病理特征差异,利用Kaplan-Meier法及Log-rank检验进行生存分析,并采用Cox比例风险模型进行多因素分析。结果:与UBUC组比较,UTUC患者中,女性患者更常见(28.6%比10.0%, P=0.012),而UTUC患者则更少发生神经侵犯(5.7%比33.7%, P=0.002)及血管侵犯(20.0%比45.0%, P=0.011),UTUC患者伴发原位癌也更为少见(2.9%比23.7%, P=0.007)。UBUC的组织学变异型主体为微乳头分化(31.3%)、鳞状分化(25.0%)和腺样分化(12.6%);而UTUC多见差分化癌(33.3%)、肉瘤样分化(22.2%)及神经内分泌分化(22.2%)。生存分析显示,UTUC患者的3年总生存率(overall survival, OS)略高于UBUC(81.8%比73.8%),但差异尚无统计学意义(P>0.05)。神经侵犯、血管侵犯、临床分期、淋巴结转移与UC患者的总生存期(overall survival,OS)相关,且血管侵犯和神经侵犯是UC患者总生存期的独立预测因子。结论:相较UBUC,UTUC女性构成比明显高于男性;UBUC则更易发生神经侵犯及血管侵犯、伴发原位癌。两者的预后并无明显差异。血管侵犯及神经侵犯是UC患者OS的独立预后因子。
中图分类号:
周晓蝶, 陈巍魏, 余波, 王璇, 王建军, 石群立, 饶秋, 鲍炜. 尿路上皮癌的临床病理学特征[J]. 诊断学理论与实践, 2023, 22(03): 292-299.
ZHOU Xiaodie, CHEN Weiwei, YU Bo, WANG Xuan, WANG Jianjun, SHI Qunli, RAO Qiu, BAO Wei. Clinicopathological features of urothelial carcinoma[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(03): 292-299.
表1
UBUC和UTUC的临床病理特征
Patient characteristics | Total (n=115) | UBUC (n=80) | UTUC (n=35) | P value |
---|---|---|---|---|
Median age | 69(36-88) | 69(36-88) | 68(45-84) | |
Gender | 0.012 | |||
Male | 97(84.4%) | 72(90.0%) | 25(71.4%) | |
Female | 18(15.6%) | 8(10.0%) | 10(28.6%) | |
Age (years) | 0.508 | |||
<60 | 16(13.9%) | 10(12.5%) | 6(17.1%) | |
≥60 | 99(86.1%) | 70(87.5%) | 29(82.9%) | |
Smoking history | 0.099 | |||
No | 95(82.6%) | 63(78.8%) | 32(91.4%) | |
Yes | 20(17.4%) | 17(21.2%) | 3(8.6%) | |
Neural invasion | 0.002 | |||
No | 86(74.8%) | 53(66.2%) | 33(94.2%) | |
Yes | 29(25.2%) | 27(33.7%) | 2(5.7%) | |
Vascular invasion | 0.011 | |||
No | 72(62.6%) | 44(55.0%) | 28(80.0%) | |
Yes | 43(37.4%) | 36(45.0%) | 7(20.0%) | |
AJCC clinical staging | 0.502 | |||
Ⅰ/Ⅱ | 44(38.3%) | 29(36.3%) | 15(42.9%) | |
Ⅲ/Ⅳ | 71(61.7%) | 51(63.7%) | 20(57.1%) | |
Single/multifocal | 0.311 | |||
Single | 92(80%) | 62(77.5%) | 30(85.7%) | |
Multifocal | 23(20%) | 18(22.5%) | 5(14.2%) | |
With carcinoma in situ | 0.007 | |||
Without | 95(82.6%) | 61(76.3%) | 34(97.1%) | |
With | 20(17.4%) | 19(23.7%) | 1(2.9%) | |
UC subtype, n (%) | 0.139 | |||
Low-grade | 5(4.3%) | 2(2.5%) | 3(8.6%) | |
High-grade | 68(59.1%) | 45(56.3%) | 23(65.7%) | |
Histological type | 42(36.5%) | 33(41.3%) | 9(25.7%) | <0.001 |
Micropapilly | 11(26.2%) | 11(33.3%) | 0(0.0%) | |
Glandular | 4(9.5%) | 4(12.1%) | 0(0.0%) | |
Squamous | 9(21.4%) | 8(24.2%) | 1(11.1%) | |
Plasmacytoid | 4(9.5%) | 4(12.1%) | 0(0.0%) | |
Sarcomatoid | 5(11.9%) | 3(9.1%) | 2(22.2%) | |
Nested | 2(4.8%) | 2(6.1%) | 0(0.0%) | |
Neuroendocrine | 2(4.8%) | 0(0.0%) | 2(22.2%) | |
Lymphoepithelioma-like | 2(4.8%) | 1(3.0%) | 1(11.1%) | |
Poorly differentiated | 3(7.1%) | 0(0.0%) | 3(33.3%) | |
Surgical margin | 0.071 | |||
Negative | 108(93.9%) | 73(91.3%) | 35(100%) | |
Positive | 7(6.1%) | 7(8.7%) | 0(0%) | |
Lymph node | <0.001 | |||
No | 27(23.5%) | 7(8.7%) | 20(57.1%) | |
Yes | 88(76.5%) | 73(91.3%) | 15(42.9%) | |
Median | 12(1-34) | 13(1-34) | 4(1-16) | |
Lymph node metastasis | 0.807 | |||
No | 61(69.3%) | 51(69.9%) | 10(66.7%) | |
Yes | 27(30.7%) | 22(30.1%) | 5(33.3%) | |
Tumor location | ||||
Renal pelvis | - | - | 16(45.7%) | |
Ureter | - | - | 17(48.5%) | |
Renal pelvis+Ureter | - | - | 2(5.7%) | |
Urethral diversion | ||||
Ileal conduit | - | 47(58.8%) | - | |
Cutaneous ureter- ostomy | - | 25(31.2%) | - | |
Orthotopic bladder substitute | - | 8(10.0%) | - | |
Surgical operation | 0.568 | |||
Open | 1(0.9%) | 1(1.3%) | 0(0) | |
Laparoscopic | 22(19.1%) | 14(17.5%) | 8(22.9%) | |
Robot-assisted | 92(80.0%) | 65(81.2%) | 27(77.1%) |
表2
115例UC患者根治术后总生存率的危险因素分析
Variables | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
HR(95%CI) | P value | HR(95%CI) | P value | |
UBUC vs. UTUC | 0.702(0.229-2.152) | 0.536 | ||
Age (years)(<60 vs. ≥60) | 0.040(0.000-15.987) | 0.292 | ||
Smoking history | 0.588(0.134-2.575) | 0.481 | ||
Gender | 2.971(0.394-22.409) | 0.291 | ||
Neural invasion | 2.688(1.021-7.079) | 0.045 | 1.607(0.595-4.343) | 0.035 |
Vascular invasion | 4.327(1.597-11.723) | 0.004 | 3.646(1.187-11.196) | 0.024 |
AJCC clinical staging(Ⅲ-Ⅳ vs. Ⅰ-Ⅱ) | 6.260(1.43-27.407) | 0.015 | 4.799(0.988-23.304) | 0.052 |
Single vs. Multifocal | 2.101(0.707-5.710) | 0.190 | ||
With carcinoma in situ | 1.371(0.394-4.774) | 0.620 | ||
Histological type | 1.437(0.531-3.890) | 0.475 | ||
Surgical margin | 1.809(0.414-7.912) | 0.431 | ||
Lymph node metastasis | 3.019(1.145-7.961) | 0.026 | 0.825(0.265-2.566) | 0.739 |
Surgical operation (Open vs. Laparoscopic vs. Robot-assisted) | 1.857(0.424-8.128) | 0.411 |
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