«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

22卷

期数:

2016年03期

页码:

213-217

栏目:

临床医学

出版日期:

2016-05-20

文章信息/Info

Title:

Influence?of squamous differentiation on prognosis?of patients with pT1 urothelial carcinoma of bladder after TURBT

文章编号:

1006-8147（2016）03-0213-05

作者:

何 振;  徐 勇 ;  齐士勇;  杜 娥 ; 沙 楠;  朱 冰

( 天津医科大学第二医院泌尿外科,天津市泌尿外科研究所,天津 300211)

Author(s):

HE Zhen;  XU Yong;  QI Shi-yong;  DU E;  SHA Nan;  ZHU Bing

(Department of Urology, The Second Hospital Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China)

关键词:

膀胱; 尿路上皮癌; 鳞状分化; TURBT; 复发; 进展

Keywords:

bladder;  urothelial carcinoma;  squamous differentiation;  TURBT;  recurrence;  progression

分类号:

R737.14

DOI:

-

文献标志码:

A

摘要:

目的: 探讨尿路上皮癌伴鳞状分化对初次经尿道膀胱肿瘤电切术（TURBT）术后pT1期患者预后的影响。方法: 回顾性分析初次经TURBT手术、术后病理诊断为T1期的尿路上皮癌的533例膀胱肿瘤患者的临床病理资料。根据患者的术后病理诊断将患者分为2组：A组为尿路上皮癌（单纯型）441例，B组为尿路上皮癌伴鳞状分化90例，应用SPSS 20.0统计软件，运用Kaplan-Meier法分析两种临床病理特点对无复发生存期（RFS）和无进展生存期（PFS）的影响, 并用Log-rank检验比较生存曲线；运用COX回归模型单因素和多因素分析膀胱尿路上皮癌伴鳞状分化与初次TURBT术后pT1期患者预后之间的关系，评估影响其RFS和PFS的因素。结果: A组单纯尿路上皮癌441例（83.05%），B组尿路上皮癌伴鳞状分化90例（16.95%）。B组与A组比较更易具有高级别肿瘤（P＜0.001），同时B组较A组有较高的复发率（P=0.018）、较短的无复发生存期（P＜0.001）以及较高的进展率（P=0.001）、较短的无进展生存期（P＜0.001）。B组与A组比较，年龄（P=0.185）、性别（P=0.135）、吸烟（P=0.728）、肿瘤大小（P=0.436）、肿瘤数目（P=0.112）和膀胱灌注（P=0.054）等差异均无统计学意义。COX多因素生存分析显示：吸烟（HR 1.34, 95% CI 1.00–1.79, P=0.048）、鳞状分化的伴发情况（HR 1.43, 95% CI 1.02–2.00, P=0.040）以及病理分级（HR 1.51, 95% CI 1.13–2.01, P=0.005）等因素显著增加TURBTpT1期患者的复发风险；同时，吸烟（HR 1.80, 95% CI 1.17–2.76, P=0.008）、鳞状分化的伴发情况（HR 2.07, 95% CI 1.32–3.24, P=0.001）以及病理分级（HR 1.90, 95% CI 1.24–2.92, P=0.003）等因素增加TURBTpT1期患者的进展风险。结论: 尿路上皮癌伴鳞状分化是TURBT术后pT1期患者的预后独立影响因素，复发率及进展率较高，需密切随访。

Abstract:

Objective: To evaluate squamous differentiation on prognostic in patients with pT1 urothelial carcinoma of bladder (UCB) after first transurethral resection (TURBT). Methods: The retrospective study based on clinicopathologic data was applied to 533 patients of pTl UCB after first TURBT? .The patients were divided into two groups：group A included 441 patients with pure UCB, and group B included 90 patients with squamous differentiation. All the data were calculated by using SPSS 20.0 statistical software (IBM Company, version20.0). Recurrence-free survival (RFS) and progression-free survival (PFS) curves were estimated to study clinicopathologic features of two groups using the Kaplan-Meier method, and the difference was determined by the log-rank test. Univariate and multivariate analyses were performed to study patient prognosis between patients with squamous differentiation and patients with pT1 UCB through using a Cox proportional hazards regression model, and the factors influencing its RFS and PFS were evaluated. Results: In this study, group A included 441 patients with pure UCB, and group B included 90 patients with squamous differentiation. High grade tumors were more common in patients with squamous differentiation than those with pure UCB (P <0.001). Meanwhile, compared with group A , group B had a higher recurrence rate (P = 0.018), shorter RFS (P < 0.001), and the progress of the higher rate (P = 0.001), shorter PFS (P < 0.001). Correlations among the age (P =0.185), gender (P =0.135), smoking (P =0.728), tumor size (P =0.436), and tumor count (P =0.112) were not statistically significant. Based on multivariate Cox regression analysis, smoking (HR 1.34, 95% CI 1.00 1.79, P =0.048), comorbid conditions of squamous differentiation (HR 1.43, 95% CI 1.02 2.00, P =0.040) and pathology classification (HR 1.51, 95% CI 1.13 2.01, P = 0.005) in patients with pT1 urothelial carcinoma of bladder after first TURBT had a higher risk of recurrence; smoking (HR 1.80, 95% CI 1.17 2.76, P = 0.008), comorbid conditions of squamous differentiation (HR 2.07, 95% CI 1.32 3.24, P = 0.001) and pathology classification (HR 1.90, 95% CI 1.24 2.92, P = 0.003) in patients with pT1 urothelial carcinoma of bladder after first TURBT had a higher risk of progress. Conclusion: UCB with squamous differentiation is an independent prognostic predictor, and the presence of squamous differentiation could be associated with higher recurrence/progress rate, and patients with this variant should be followed up closely

参考文献/References:

[1] Torre L A, Bray F, Siegel R L, et al. Global cancer statistics, 2012[J]. CA Cancer J Clin,2015,65(2):87
[2] Kurth K H, Denis L, Bouffioux C, et al. Factors affecting recurrence and progression in superficial bladder tumours[J]. Eur J Cancer,1995,31A(11):1840
[3] Allard P, Bernard P, Fradet Y, et al. The early clinical course of primary Ta and T1 bladder cancer: a proposed prognostic index[J]. Br J Urol,1998,81(5):692
[4] Samaratunga H, Delahunt B. Recently described and unusual variants of urothelial carcinoma of the urinary bladder[J]. Pathology,2012,44(5):407
[5] Xylinas E, Rink M, Robinson B D, et al. Impact of histological variants on oncological outcomes of patients with urothelial carcinoma of the bladder treated with radical cystectomy[J]. Eur J Cancer, 2013,49(8):1889
[6] Shah R B, Montgomery J S, Montie J E, et al. Variant (divergent) histologic differentiation in urothelial carcinoma is under-recognized in community practice: impact of mandatory central pathology review at a large referral hospital[J]. Urol Oncol, 2013,31(8):1650
[7] Kim S P, Frank I, Cheville J C, et al. The impact of squamous and glandular differentiation on survival after radical cystectomy for urothelial carcinoma[J]. J Urol, 2012,188(2):405
[8] Abd E A, Watts K E, Elson P, et al. The sensitivity of initial transurethral resection or biopsy of bladder tumor(s) for detecting bladder cancer variants on radical cystectomy[J]. J Urol, 2013,189(4):1263
[9] Yang M H, Yen C C, Chen P M, et al. Prognostic-factors-based risk-stratification model for invasive urothelial carcinoma of the urinary bladder in Taiwan[J]. Urology, 2002,59(2):232, 238
[10] Lopez-Beltran A, Requena M J, Alvarez-Kindelan J, et al. Squamous differentiation in primary urothelial carcinoma of the urinary tract as seen by MAC387 immunohistochemistry[J]. J Clin Pathol, 2007,60(3):332
[11] Antunes A A, Nesrallah L J, Dall’Oglio M F, et al. The role of squamous differentiation in patients with transitional cell carcinoma of the bladder treated with radical cystectomy[J]. Int Braz J Urol, 2007,33(3):339, 346
[12] Erdemir F, Tunc M, Ozcan F, et al. The effect of squamous and/or glandular differentiation on recurrence, progression and survival in urothelial carcinoma of bladder[J]. Int Urol Nephrol, 2007,39(3):803
[13] Chalasani V, Chin J L, Izawa J I. Histologic variants of urothelial bladder cancer and nonurothelial histology in bladder cancer[J]. Can Urol Assoc J, 2009,3(6 Suppl 4):S193
[14] Mazzucchelli L, Bacchi M, Studer U E, et al. Invasion depth is the most important prognostic factor for transitional-cell carcinoma in a prospective trial of radical cystectomy and adjuvant chemotherapy[J]. Int J Cancer,1994,57(1):15
[15] Honma I, Masumori N, Sato E, et al. Local recurrence after radical cystectomy for invasive bladder cancer: an analysis of predictive factors[J]. Urology, 2004,64(4):744
[16] Jozwicki W, Domaniewski J, Skok Z, et al. Usefulness of histologic homogeneity estimation of muscle-invasive urinary bladder cancer in an individual prognosis: a mapping study[J]. Urology, 2005,66(5):1122
[17] Gaisa N T, Braunschweig T, Reimer N, et al. Different immunohistochemical and ultrastructural phenotypes of squamous differentiation in bladder cancer[J]. Virchows Arch, 2011,458(3):301
[18] Cao L, Zhou X D, Sens M A, et al. Keratin 6 expression correlates to areas of squamous differentiation in multiple independent isolates of As(+3)-induced bladder cancer[J]. J Appl Toxicol, 2010,30(5):416
[19] Hayashi T, Sentani K, Oue N, et al. Desmocollin 2 is a new immunohistochemical marker indicative of squamous differentiation in urothelial carcinoma[J]. Histopathology, 2011,59(4):710
[20] Ehdaie B, Maschino A, Shariat S F, et al. Comparative outcomes of pure squamous cell carcinoma and urothelial carcinoma with squamous differentiation in patients treated with radical cystectomy[J]. J Urol, 2012,187(1):74
[21] Scosyrev E, Ely B W, Messing E M, et al. Do mixed histological features affect survival benefit from neoadjuvant platinum-based combination chemotherapy in patients with locally advanced bladder cancer? A secondary analysis of Southwest Oncology Group-Directed Intergroup Study (S8710)[J]. BJU Int, 2011,108(5):693
[22] Kastritis E, Dimopoulos M A, Antoniou N, et al. The outcome of patients with advanced pure squamous or mixed squamous and transitional urothelial carcinomas following platinum-based chemotherapy[J]. Anticancer Res, 2006,26(5B):3865
[23] Mitra A P, Bartsch C C, Bartsch G J, et al. Does presence of squamous and glandular differentiation in urothelial carcinoma of the bladder at cystectomy portend poor prognosis? An intensive case-control analysis[J]. Urol Oncol, 2014,32(2):117
[24] Rogers C G, Palapattu G S, Shariat S F, et al. Clinical outcomes following radical cystectomy for primary nontransitional cell carcinoma of the bladder compared to transitional cell carcinoma of the bladder[J]. J Urol, 2006,175(6):2048, 2053
[25] Coulson W F. Clinical importance of squamous metaplasia in invasive transitional cell carcinoma of the bladder[J]. J Clin Pathol, 1989,42(11):1227
[26] Miller J S, Epstein J I. Noninvasive urothelial carcinoma of the bladder with glandular differentiation: report of 24 cases[J]. Am J Surg Pathol, 2009,33(8):1241
[27] Frazier H A, Robertson J E, Dodge R K, et al. The value of pathologic factors in predicting cancer-specific survival among patients treated with radical cystectomy for transitional cell carcinoma of the bladder and prostate[J]. Cancer,1993,71(12):3993
[28] Martin J E, Jenkins B J, Zuk R J, et al. Clinical importance of squamous metaplasia in invasive transitional cell carcinoma of the bladder[J]. J Clin Pathol,1989,42(3):250
[29] Billis A, Schenka A A, Ramos C C, et al. Squamous and/or glandular differentiation in urothelial carcinoma: prevalence and significance in transurethral resections of the bladder[J]. Int Urol Nephrol, 2001,33(4):631

相似文献/References:

[1]刘 豫,薄志强,张志宏.糖尿病及二甲双胍对上尿路肿瘤术后复发的影响[J].天津医科大学学报,2017,23(01):53.
　LIU Yu,BO Zhi-qiang,ZHANG Zhi-hong.Effect of diabetes mellitus and metformin on intravesical recurrence after radical operation in patients with upper urinary tract urothelial carcinoma[J].Journal of Tianjin Medical University,2017,23(03):53.
[2]费夏俊,林 毅.9例膀胱小细胞癌诊治分析[J].天津医科大学学报,2019,25(02):173.

备注/Memo

备注/Memo:

作者简介 何振(1989-) ，男，硕士在读，研究方向：泌尿系肿瘤；通信作者: 徐勇，E-mail:Drxuyong@126.com。

常用功能

更新日期/Last Update: 2016-05-25