Aamand Mads, Brandt Simone Buchardt, Milling Rikke Vilsbøll, Jensen Jørgen Bjerggaard
Department of Urology, Aarhus University Hospital, 8200 Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark.
Cancers (Basel). 2025 Mar 3;17(5):867. doi: 10.3390/cancers17050867.
The aim of this study is to assess the prognostic implications of metastatic anatomical location in patients with recurrent bladder cancer (BC) after cystectomy. The study is a retrospective cohort study. All data were collected from a clinical database from Aarhus University Hospital. Kaplan-Meier curves were used to analyse survival probabilities. Crude and adjusted Cox regression was used to calculate the hazard ratios (HRs) for overall mortality between different locations of metastases and the number of metastases. In total, 180/664 (27.1%) patients who underwent radical cystectomy as a treatment of BC in the time period from 2015 to 2021 ultimately developed recurrent disease. The median follow-up period was 433 days (Q1: 256, Q3; 847). In a crude analysis for overall mortality, patients with both lymph node and distant organ metastasis had a worse prognosis than patients with lymph node metastasis only (HR = 2.25 (95% CI: 1.36-3.75, = 0.002)). In the adjusted analysis, patients with ≥2 metastatic sites had higher hazard than patients with only a single site of recurrence (HR = 1.63 (95% CI: 1.15-2.33, = 0.01)). Patients with organ metastasis had higher hazard ratios than patients with lymph node metastases and local recurrence only (HR = 1.74 (95% CI: 1.07-2.84, = 0.026)). When analysing patients with single metastasis, there was a statistically significant difference in overall survival probability in the following groups: lymph node metastasis, other organ metastases, bone metastasis ( = 0.04). This study shows potentially clinically relevant associations between the anatomical location of metastases and patients' prognosis. Furthermore, we were able to demonstrate an association between a higher number of metastatic sites and a worse prognosis.
本研究的目的是评估膀胱切除术后复发性膀胱癌（BC）患者转移灶的解剖位置对预后的影响。该研究为一项回顾性队列研究。所有数据均从奥胡斯大学医院的临床数据库中收集。采用Kaplan-Meier曲线分析生存概率。使用粗 Cox 回归和校正后的 Cox 回归计算不同转移部位和转移灶数量之间全因死亡率的风险比（HR）。2015年至2021年期间，共有180/664（27.1%）例接受根治性膀胱切除术治疗BC的患者最终出现疾病复发。中位随访期为433天（第一四分位数：256，第三四分位数：847）。在全因死亡率的粗分析中，有淋巴结和远处器官转移的患者比仅发生淋巴结转移的患者预后更差（HR = 2.25（95%置信区间：1.36 - 3.75，P = 0.002））。在校正分析中，有≥2个转移部位的患者比仅有单个复发部位的患者风险更高（HR = 1.63（95%置信区间：1.15 - 2.33，P = 0.01））。有器官转移的患者比仅有淋巴结转移和局部复发的患者风险比更高（HR = 1.74（95%置信区间：1.07 - 2.84，P = 0.026））。在分析单个转移灶的患者时，以下组间的总生存概率存在统计学显著差异：淋巴结转移、其他器官转移、骨转移（P = 0.04）。本研究显示转移灶的解剖位置与患者预后之间可能存在具有临床相关性的关联。此外，我们能够证明转移部位数量较多与预后较差之间存在关联。
