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。

Objective: This paper aims to investigate the clinicopathological features of bladder cancer (UBUC) and upper urinary tract cancer (UTUC). Methods: A total of 115 patients with urothelial carcinoma (UC) admitted to Jinling Hospital and Nanjing Drum Tower Hospital from May 2017 to February 2020 were randomly selected and retrospectively analyzed, including 80 cases of UBUC and 35 cases of UTUC. The differences in clinicopathological characteristics between the two groups were analyzed by chi-square test and Fisher’s exact test. Kaplan-Meier method and Log-rank test were used for survival analysis, and Cox proportional hazards model was used for multivariate analysis. Results: Female patients were more common in UTUC (28.6% vs. 10.0%, P=0.012). UBUC was more likely to have neural invasion (33.7% vs.5.7%, P=0.002), vascular invasion (45.0% vs. 20.0%, P=0.011), and carcinoma in situ (23.7% vs. 2.9%, P=0.007). The main histological variants of UBUC were micropapillary differentiation (31.3%), squamous differentiation (25.0%) and adenoid differentiation (12.6%), while poorly differentiated carcinoma (33.3%), sarcomatoid differentiation (22.2%) and neuroendocrine differentiation (22.2%) were more common in UTUC. Survival analysis showed that there was no significant difference in overall survival (OS) between UTUC and UBUC (P>0.05). Neural invasion, vascular invasion, clinical stage, and lymph node metastasis are associated with OS in UC, and vascular invasion and neural invasion are independent predictors of overall survival in UC. Conclusions: Compared with UBUC, the incidence of UTUC in women is significantly higher than that in men, while UBUC is more likely to have neural invasion, vascular invasion and carcinoma in situ. Histological variants of UBUC are micropapillary, squamous and adenoid, while UTUC is mostly poorly differentiated carcinoma, sarcomatoid and neuroendocrine differentiation. There is no significant difference in prognosis between the two groups. Vascular invasion and neural invasion are significant predictors of UC-OS.