Jue Joshua S, Koru-Sengul Tulay, Moore Kevin J, Miao Feng, Alameddine Mahmoud, Nahar Bruno, Punnen Sanoj, Parekh Dipen J, Ritch Chad R, Gonzalgo Mark L
Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA.
Can J Urol. 2018 Feb;25(1):9179-9185.
To investigate the impact of perioperative factors on overall survival among patients with histologic variants of bladder cancer treated with radical cystectomy.
The National Cancer Data Base was utilized to identify patients diagnosed with muscle-invasive bladder cancer (cT2-4, N0, M0) from 2004-2013. Variant histology bladder cancers (non-mucinous adenocarcinoma, mucinous/signet ring adenocarcinoma, micropapillary urothelial carcinoma, small cell carcinoma, and squamous cell carcinoma) were compared to urothelial carcinoma with respect to overall survival. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated from a multivariable Cox regression model to examine factors affecting overall survival, T upstaging, N upstaging, and positive surgical margins. Median survival was calculated using Kaplan-Meier analysis.
A total of 5,856 patients were included in this study. Significant predictors of worse overall survival included: African-American ancestry (aHR = 1.24, 95%CI: 1.03-1.48, p = 0.021), age (1.03, 1.02-1.03, p < 0.001), comorbidity (1.30, 1.20-1.40, p < 0.001), cT3 stage (1.41, 1.26-1.57, p < 0.001), and cT4 stage (1.59, 1.38-1.84, p < 0.001). Small cell carcinoma (2.10, 1.44-3.06, p < 0.001) and non-mucinous adenocarcinoma (1.59, 1.15-2.20, p = 0.005) were significant predictors of worse overall survival compared to urothelial carcinoma. Small cell carcinoma had the worst 5 year overall survival (15.5%, 95% CI: 5.2%-30.9%) compared to urothelial carcinoma (48.7%, 95% CI: 47.2%-50.2%). Micropapillary urothelial carcinoma was a significant predictor of increased progression to node positivity and positive margin status after radical cystectomy compared to urothelial carcinoma (6.01, 3.11-11.63, p < 0.001; 4.38, 2.05-9.38; p < 0.001).
Among bladder cancer patients with equal treatment and staging, small cell carcinoma and non-mucinous adenocarcinoma variant histologies were predictive of worse overall survival compared to urothelial carcinoma. Patient demographics such as African-American ancestry and age were also predictive of worse overall survival among variant histology bladder cancer and urothelial carcinoma.
探讨围手术期因素对接受根治性膀胱切除术治疗的膀胱癌组织学亚型患者总生存期的影响。
利用国家癌症数据库识别2004年至2013年期间诊断为肌层浸润性膀胱癌（cT2-4，N0，M0）的患者。将变异组织学类型的膀胱癌（非黏液腺癌、黏液/印戒腺癌、微乳头尿路上皮癌、小细胞癌和鳞状细胞癌）与尿路上皮癌在总生存期方面进行比较。通过多变量Cox回归模型计算调整后的风险比（aHR）和95%置信区间（95%CI），以检验影响总生存期、T分期上调、N分期上调和手术切缘阳性的因素。采用Kaplan-Meier分析计算中位生存期。
本研究共纳入5856例患者。总生存期较差的显著预测因素包括：非裔美国人血统（aHR = 1.24，95%CI：1.03 - 1.48，p = 0.021）、年龄（1.03，1.02 - 1.03，p < 0.001）、合并症（1.30，1.20 - 1.40，p < 0.001）、cT3期（1.41，1.26 - 1.57，p < 0.001）和cT4期（1.59，1.38 - 1.84，p < 0.001）。与尿路上皮癌相比，小细胞癌（2.10，1.44 - 3.06，p < 0.001）和非黏液腺癌（1.59，1.15 - 2.20，p = 0.005）是总生存期较差的显著预测因素。与尿路上皮癌（48.7%，95%CI：47.2% - 50.2%）相比，小细胞癌的5年总生存期最差（15.5%，9%CI：5.2% - 30.9%）。与尿路上皮癌相比，微乳头尿路上皮癌是根治性膀胱切除术后淋巴结转移阳性和切缘阳性进展增加的显著预测因素（6.01，3.11 - 11.6），p < 0.001；4.38，2.05 - 9.38；p < 0.001）。
在接受相同治疗和分期的膀胱癌患者中，与尿路上皮癌相比，小细胞癌和非黏液腺癌变异组织学类型预示着更差的总生存期。非裔美国人血统和年龄等患者人口统计学特征在变异组织学类型膀胱癌和尿路上皮癌中也预示着更差的总生存期。
