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Title: [Prognostic analysis of patients with T1 stage high grade of bladder urothelial carcinoma and glandular differentiation].
Author: Wang C, Sun ZQ, Liu MY, Zhang JJ, Liu G, Feng Y, Yan YF, Cui HW, Li G.
Journal: Zhonghua Zhong Liu Za Zhi; 2021 Jun 23; 43(6):691-695. PubMed ID: 34289563.
Abstract:
Objective: To evaluate the recurrence and progression of patients with pT1 high grade urothelial carcinoma of bladder (UCB) and glandular differentiation. Methods: We retrospectively analyzed the clinical and pathological information of 208 patients diagnosed as pT1 high grade urothelial carcinoma in the Fifth Central Hospital of Tianjin from January 2006 to February 2019.Among them, 78 cases were diagnosed as glandular differentiation (UCGD), the other 130 patients without histologic variants were served as control. The UCGD group included 62 male and 16 female, whose median age was 67 years old (range 38-81 years old). The control group contained 105 male and 25 female, whose median age was 66 years old (range 40-82 years old). Kaplan-Meier and Cox proportional hazard regression analyses were used to evaluate the predictors of oncologic outcomes. Results: The disease recurrence rate and progression rate in UCGD group were 65.4% (51/78) and 28.2% (22/78), higher than 38.5%(50/130) and 14.6%(19/130) of control group (P<0.05). The median recurrence time in UCGD group was 41 months while 55 months in the control group. The median progression time in UCGD group was 39 months while 54 months in the control group. According to the univariate analysis, largest tumor size (P=0.030), UCGD (P=0.003) and lymphovascular invasion (LVI) (P=0.032) were associated with disease recurrence. UCGD (P=0.036) and LVI (P=0.011) were associated with progression. Additionally, Cox multivariate analysis revealed that UCGD (P=0.001), LVI (P=0.038) were the independent factors of disease recurrence. UCGD (P=0.007) and LVI (P=0.037) were also found to be the independent factors of disease progression. Conclusions: Patients with T1 stage UCB and UCGD are at higher risk of disease recurrence and progression. Therefore, these patients should be followed up closely after being diagnosed and undergo individual treatment according to the situation. 目的： 探讨T1期高级别膀胱尿路上皮癌伴腺样分化患者的预后情况。 方法： 回顾性分析2006年1月至2019年2月天津市第五中心医院收治的208例T1期高级别膀胱癌患者的资料，其中伴腺样分化组78例，单纯尿路上皮癌组130例，比较两组患者的预后情况。伴腺样分化组男性62例，女性16例；年龄38～81岁，中位年龄67岁。单纯尿路上皮癌组男性105例，女性25例；年龄40～82岁，中位年龄66岁。采用Cox比例风险模型法进行单因素和多因素分析，Kaplan-Meier方法分析两组无复发生存率和无进展生存率。 结果： 伴腺样分化组复发51例(65.4%, 51/78)，进展22例(28.2%, 22/78)，复发率和进展率均明显高于单纯尿路上皮癌组[分别为38.5%(50/130)和14.6%(19/130),均P<0.05]。伴腺样分化组患者的中位复发时间为41个月，单纯尿路上皮癌组患者的中位复发时间为55个月。伴腺样分化组复发患者的中位进展时间为39个月，单纯尿路上皮癌组复发患者的中位进展时间为54个月。Cox单因素分析显示，肿瘤最大径(P＝0.030)、伴腺样分化(P＝0.003)和淋巴血管侵犯(P＝0.032)与膀胱尿路上皮癌患者的肿瘤复发有关。伴腺样分化(P＝0.036)和淋巴血管侵犯(P＝0.011)与膀胱尿路上皮癌患者的疾病进展有关。Cox多因素分析显示，伴腺样分化(P＝0.001)、淋巴血管侵犯(P＝0.038)是影响膀胱尿路上皮癌患者复发的独立因素。伴腺样分化(P＝0.007)和淋巴血管侵犯(P＝0.037)是影响膀胱尿路上皮癌患者进展的独立因素。 结论： T1期高级别膀胱尿路上皮癌伴腺样分化患者有更高的疾病复发和进展风险，此类患者应密切随访，根据具体情况行个体化综合治疗。.

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