膀胱癌根治性膀胱切除术联合Mainz PouchⅡ代膀胱术后的预后风险回顾性观察研究

Retrospective study on prognostic risk following radical cystectomy combined with Mainz Pouch II reservoir for bladder cancer

  • 摘要:
    目的 本研究旨在评估包括年龄、性别、肿瘤分期、分级、肿瘤分化、淋巴结转移(lymph node metastasis,LNM)、肿瘤发生频率、肿瘤数量等临床和组织病理学参数在接受根治性膀胱切除术(rdical cystectomy,RC)联合Mainz PouchⅡ代膀胱治疗的患者结局中的预后因素。
    方法 本研究纳入了2004年1月至2023年1月间接受RC联合Mainz PouchⅡ代膀胱手术而未接受化疗或放疗治疗的237例膀胱癌患者。本研究使用Kaplan-Meier法和Cox回归分析评估了年龄、肿瘤分级、分期、肿瘤分化、LNM、肿瘤发生频率和肿瘤数量对5年总生存率(overall survival,OS)和5年癌症特异性生存率(cancer-specific survival,CSS)的影响。
    结果 患者诊断时的平均年龄为59.8岁,其中男性198例,女性39例。平均随访时间为47.8个月。在单变量分析中,年龄<65岁的患者5年OS和5年CSS显著高于年龄≥65岁的患者;且尿路上皮癌患者的5年OS高于非尿路上皮癌患者;5年OS、CSS与肿瘤分期、分级及LNM呈负相关关系。在多变量分析中,仅肿瘤分级和LNM仍然呈显著性差异(P<0.05)。
    结论 肿瘤分级和LNM被认为是RC联合Mainz PouchⅡ代膀胱术后与5年OS、CSS相关的独立预后风险因素。此外,应用RC联合Mainz PouchⅡ代膀胱应考虑患者的意愿及身体状况。

     

    Abstract:
    Objective  This study aimed to evaluate the prognostic factors of clinical and histopathological parameters, including age, gender, tumor stage, tumor grade, tumor differentiation, lymph node metastasis (LNM), tumor frequency, and tumor count, in patients undergoing radical cystectomy (RC) combined with Mainz PouchⅡ bladder reconstruction.
    Methods  A total of 237 bladder cancer patients (198 male and 39 female) who underwent RC combined with Mainz Pouch Ⅱ bladder reconstruction without chemotherapy or radiotherapy, from January 2004 to January 2023, were included in this study. Kaplan-Meier and Cox regression analyses were performed to assess the impact of age, tumor grade, tumor stage, tumor differentiation, LNM, tumor frequency, and tumor count on 5-year overall survival (OS) and 5-year cancer-specific survival (CSS).
    Results The mean age at diagnosis was 59.8 years, with 198 male and 39 female patients. The mean follow-up duration was 47.8 months. In univariate analysis, patients younger than 65 years had significantly higher 5-year OS and 5-year CSS compared to those aged ≥65 years. Patients with urothelial carcinoma showed better 5-year OS than those with non-urothelial carcinoma. Additionally, tumor stage, tumor grade, and LNM were negatively associated with 5-year OS and 5-year CSS. On multivariate analysis, only tumor grade and LNM remained statistically significant (P<0.05).
    Conclusions Tumor grade and LNM were identified as independent prognostic risk factors for 5-year OS and 5-year CSS following RC combined with Mainz PouchⅡ bladder reconstruction. Moreover, the application of RC combined with Mainz Pouch Ⅱ bladder reconstruction should consider the patient’s preferences and physical condition.

     

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