-
摘要:
目的 探讨影响局部肌层浸润性膀胱癌患者长期生存的预后因素。 方法 回顾性分析2002年1月至2011年6月新疆医科大学第一附属医院肿瘤中心收治的133例局部浸润性膀胱癌患者临床资料,选择年龄、合并症、肾积水、肿瘤大小、病灶数目、T分期、淋巴结转移、病理类型、肿瘤分级、治疗方式等10个对预后可能产生影响的因素,采用Kaplan-Meier法和Log-rank检验,对有意义的单因素进行Cox多因素分析。 结果 随访4~114个月,全组患者1、3、5年生存率分别为77%、64%、52%。单因素分析显示T分期、淋巴结及肾积水对预后的影响有统计学意义(P < 0.05)。Cox多因素分析显示影响局部肌层浸润性膀胱癌患者预后的因素分别为:T分期(RR=2.001,P=0.001)、淋巴结(RR=2.250,P=0.045)、肾积水(RR=1.954,P=0.047)。 结论 肿瘤T分期、淋巴结转移及肾积水是局部肌层浸润性膀胱癌患者的预后影响因素。 Abstract:Objective This study aims to investigate the prognostic factors affecting the survival of patients with local muscle-invasive bladder cancer. Methods The clinical and follow-up data of 133 patients with local muscle-invasive bladder cancer were retrospectively analyzed. Fourteen possible prognostic factors included gender, age, nationality, smoking habits, alcohol drinking habits, coexisting disease, hydronephrosis, tumor size, multifocality, T stage, lymph node staging, pathological type, histological grade, treatments via the Kaplan-Meier method, or the Log-rank test. Multivariate analysis was performed using the Cox proportional hazard model. Results The follow-up period ranged from 4 months to 114 months. The 1-, 3-, and 5-year survival rates were 77%, 64%, and 52%, respectively. Univariate analysis showed that the T stage, lymph node staging, and hydronephrosis were prognosis factors (P < 0.05). Multivariate analysis by the Cox proportional hazard model showed T stage (RR = 2.001, P = 0.001), lymph node staging (RR = 2.250, P = 0.045), and hydronephrosis (RR = 1.954, P = 0.047) as the prognostic factors (P < 0.05). Conclusion Hydronephrosis, T stage, and lymph node staging were prognostic factors of local muscle-invasive bladder cancer. -
Key words:
- Bladder neoplasms /
- Cox proportional hazard model /
- Prognostic factors
-
表 1 生存率影响因素的单因素分析
Table 1. Prognostic factors for overall survival
表 2 T分期、淋巴结转移及肾积水的Cox多因素分析
Table 2. The Cox multivariate analysis of T stage, lymph node staging, and hydronephrosis
-
[1] Jemal A, Siegel R, Xu J, et al. Cancer statistics, 2010[J]. CA Cancer J Clin, 2010, 60(5): 277-300. doi: 10.3322/caac.20073 [2] 陈竺. 全国第三次全国死因回顾抽样调查报告[R]. 北京: 中国协和医科大学出版社, 2008: 24. [3] 余绍龙, 周芳坚, 秦自科, 等. 217例膀胱移行细胞癌外科治疗的临床分析[J]. 癌症杂志, 2006, 25(1): 73-75. https://www.cnki.com.cn/Article/CJFDTOTAL-AIZH200601016.htm [4] Giannarini G, Kessler TM, Thoeny HC, et al. Do patients benefit from routine follow-up to detect recurrences after radical cystectomy and ileal orthotopic bladder substitution?[J]. Eur Urol 2010, 58 (4): 486-494. doi: 10.1016/j.eururo.2010.05.041 [5] Rodel C, Grabenbauer GC, Kuhn R, et al. Combined-modality treatment and selective organ Preservation in invasive bladder cancer: long-term results[J]. J Clin Oncol, 2002, 20(14): 3061-3071. doi: 10.1200/JCO.2002.11.027 [6] 杨柏帅, 叶定伟, 沈益君, 等. 年龄对膀胱癌根治术的影响及预后分析[J]. 中国癌症杂志, 2009, 11(19): 851-855. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGAZ200911013.htm [7] Noguchi S, Takase K, Yoshida M, et al. Effectiveness of neoadjuvant chemotherapy for the patients with locally invasive bladder cancer[J]. Nippon Hinyokika Gakkai Zasshi, 2005, 96(5): 548-553. http://www.jstage.jst.go.jp/article/jpnjurol1989/96/5/96_5_548/_pdf [8] 沈捷, 刘峡, 张福泉, 等. 109例膀胱癌三维适形放疗临床分析[J], 中华放射肿瘤学杂志, 2009, 2(18): 115-119. [9] Bartsch GC, Kuefer R, Gschwend JE, et al. Hydronephrosis as a prognostic marker in bladder cancer in a cystectomy only series[J]. Eur Urol 2007, 51(3): 690-7. doi: 10.1016/j.eururo.2006.07.009 [10] 周丽娜, 朱鸣阳, 李成文. 浸润性膀胱肿瘤患者预后影响因素COX分析[J]. 武警医学学报, 2011, 05(20): 391-394. https://www.cnki.com.cn/Article/CJFDTOTAL-WUXB201105027.htm