Telli Onur, Sarici Hasmet, Ozgur Berat Cem, Doluoglu Omer Gokhan, Sunay Mehmet Melih, Bozkurt Selen, Eroglu Muzaffer
Clinic of Urology, Ankara Training and Research Hospital, Ankara, Turkey.
Clinic of Urology, Ankara Training and Research Hospital, Ankara, Turkey.
Kaohsiung J Med Sci. 2014 Sep;30(9):466-70. doi: 10.1016/j.kjms.2014.02.017. Epub 2014 Apr 24.
Bladder urothelial carcinoma is rare in young adults and occurs more commonly in older individuals. The aim of this study was to compare the clinical behavior, pathologic characteristics, and prognosis of urothelial carcinoma of urinary bladder in young versus older adults. A retrospective review of our records between 2007 and 2013 identified 56 patients (42 males and 14 females) with transitional cell carcinoma of the bladder who were less than 40 years old. Clinical and pathological parameters of patients who were less than 40 years of age were compared with those of a series of patients older than 40 years of age (the control group) during the same period. A survival analysis was performed using the Kaplan-Meier method and log-rank test, and Cox regression was performed to identify clinical parameters that affected the clinical outcomes. The mean age was 29.21 years (range, 5-40 years) for patients less than 40 years old and 61.66 years (range, 41-75) for those older than 40 years. The mean follow-up was 40.26 months (range, 12-65 months) for young patients and 42.57 months (range, 12-72 months) for the older patients. Young bladder cancer patients had smaller-sized tumors (less than 3 cm), less high-grade cancers, higher papillary urothelial neoplasms of low malignant potential, and low-grade tumors than patients older than 40 years. Multivariate logistic regression analysis predicted tumor recurrence in young patients with high-grade tumors [odds ratio (OR), 1.959; 95% confidence interval (CI), 1.235-2.965; p = 0.046] and tumors larger than 3 cm (OR, 1.772; 95% CI, 1.416-1.942; p = 0.032). The 5-year overall survival rate was 100% for young patients and 88.1% for older patients. No difference was observed in the recurrence-free (p = 0.321) and progression-free (p = 0.422) survival rates between the two groups. We concluded that although the clinical stage distribution, natural history, and outcomes of bladder urothelial cancer in young adults are similar to those in their older counterparts, clinicians must be aware that patients under 40 years of age presented with higher-grade and larger (>3 cm) tumors and are more likely to experience tumor recurrence.
膀胱尿路上皮癌在年轻人中较为罕见，在老年人中更为常见。本研究的目的是比较年轻与老年成年人膀胱尿路上皮癌的临床行为、病理特征及预后。回顾性分析我们2007年至2013年期间的记录，确定了56例膀胱移行细胞癌患者（42例男性和14例女性），年龄小于40岁。将年龄小于40岁患者的临床和病理参数与同期一系列年龄大于40岁的患者（对照组）进行比较。采用Kaplan-Meier法和对数秩检验进行生存分析，并进行Cox回归以确定影响临床结局的临床参数。年龄小于40岁的患者平均年龄为29.21岁（范围5 - 40岁），年龄大于40岁的患者平均年龄为61.66岁（范围41 - 75岁）。年轻患者的平均随访时间为40.26个月（范围12 - 65个月），老年患者为42.57个月（范围12 - 72个月）。与年龄大于40岁的患者相比，年轻膀胱癌患者的肿瘤体积较小（小于3 cm），高级别癌症较少，低恶性潜能的乳头状尿路上皮肿瘤较多，低级别肿瘤较多。多因素逻辑回归分析预测，高级别肿瘤（比值比[OR]，1.959；95%置信区间[CI]，1.235 - 2.965；p = 0.046）和大于3 cm的肿瘤（OR，1.772；95% CI，1.416 - 1.942；p = 0.032）的年轻患者更容易出现肿瘤复发。年轻患者的5年总生存率为100%，老年患者为88.1%。两组之间的无复发生存率（p = 0.321）和无进展生存率（p = 0.422）没有差异。我们得出结论，尽管年轻成年人膀胱尿路上皮癌的临床分期分布、自然史和结局与老年患者相似，但临床医生必须意识到，40岁以下的患者出现高级别和更大（>3 cm）肿瘤的可能性更高，且更容易出现肿瘤复发。
