Kucuk Ulku, Pala Emel Ebru, Cakır Ebru, Sezer Ozlem, Bayol Umit, Divrik Rauf Taner, Cakmak Ozgur
Izmir Tepecik Research and Training Hospital, Department of Pathology, Izmir, Turkey.
Sifa Universitiy Medical Faculty, Department of Urology, Izmir, Turkey.
Cent European J Urol. 2015;68(1):30-6. doi: 10.5173/ceju.2015.01.465. Epub 2015 Mar 13.
Our aim is to evaluate the influence of clinical and histopathological parameters, including age, gender, tumor stage, grade, tumor differentiation, necrosis, lymphovascular/perineural invasion (LVI/PNI) and concomitant carcinoma in situ (CIS), on outcomes of patients with urothelial carcinoma of the bladder (UCB).
A total of 84 patients who underwent radical cystectomy (RC) (n = 11) and radical cystoprostatectomy (n = 73) for muscle-invasive bladder cancer at our hospital between 2007-2013, were included in the study.
The mean age of patients at diagnosis was 66.1, of whom 75 were males and 9 were females. Of the 84 patients, 38 were ≤65 years and 46 were >65 years. Mean tumor diameter was 3.66 cm. There were 38 cases which showed divergent differentiations. Concomitant CIS was observed in 30 tumors, 41 cases showed tumor necrosis, 44 PNI and 61 LVI. The rate of overall survival (OS) in patients aged ≤65 years was statistically significantly higher than in those aged >65 years. A negative statistical relationship was found between OS with lymph node metastasis (LNM) and tumor differentiation. On the other hand, necrosis did not remain significant on multivariate analysis. No statistically significant relationship was found between smoking, tumor stage, PNI, LVI and concomitant CIS and OS.
In this study, advanced age, LNM, tumor differentiation were found to be independent prognostic risk factors associated with OS after RC. These additional factors, which may explain the different clinical course in patients with similar tumor stage and lymph node status, should be taken into consideration in treatment planning.
我们的目的是评估临床和组织病理学参数，包括年龄、性别、肿瘤分期、分级、肿瘤分化、坏死、淋巴管/神经周围浸润（LVI/PNI）和原位癌（CIS）对膀胱尿路上皮癌（UCB）患者预后的影响。
2007年至2013年期间在我院因肌层浸润性膀胱癌接受根治性膀胱切除术（RC）（n = 11）和根治性膀胱前列腺切除术（n = 73）的84例患者纳入本研究。
患者诊断时的平均年龄为66.1岁，其中男性75例，女性9例。84例患者中，38例年龄≤65岁，46例年龄>65岁。平均肿瘤直径为3.66 cm。有38例显示出不同程度的分化。30个肿瘤中观察到合并原位癌，41例显示肿瘤坏死，44例有神经周围浸润，61例有淋巴管浸润。年龄≤65岁患者的总生存率（OS）在统计学上显著高于年龄>65岁的患者。总生存率与淋巴结转移（LNM）和肿瘤分化之间存在负相关的统计学关系。另一方面，在多变量分析中，坏死不再具有显著性。吸烟、肿瘤分期、神经周围浸润、淋巴管浸润和合并原位癌与总生存率之间未发现统计学上的显著关系。
在本研究中，发现高龄、淋巴结转移、肿瘤分化是与根治性膀胱切除术后总生存率相关的独立预后危险因素。这些可能解释具有相似肿瘤分期和淋巴结状态患者不同临床病程的额外因素，在治疗计划中应予以考虑。
