膀胱鳞状细胞癌和膀胱腺癌的临床病理特征及预后分析

目的探讨膀胱鳞状细胞癌(SqCC)和膀胱腺癌的临床病理特征及预后相关因素。方法回顾性分析郑州大学第一附属医院2011年10月至2019年1月收治的107例膀胱非尿路上皮癌(NUBC)患者的病例资料。男78例,女29例,男女比例为2.69∶1;中位年龄62.0(51.0,72.0)岁。根据组织学类型将患者分为SqCC组、脐尿管腺癌组和非脐尿管腺癌组。SqCC组55例,男40例,女15例;年龄69.0(58.0,75.0)岁;有吸烟史14例;就诊原因为血尿35例,膀胱刺激征13例,排尿困难2例,疼痛5例;肿瘤位于前后壁18例,侧壁27例,三角区8例,顶壁2例;肿瘤直径4.5(3.0,6.0)cm;肿瘤单发37例,多发18例;行根治性膀胱切除术38例,膀胱部分切除术4例,经尿道膀胱肿瘤切除术(TURBT)9例,介入手术2例,未手术2例。脐尿管腺癌组20例,男14例,女6例;年龄53.5(43.5,57.8)岁;有吸烟史6例;就诊原因为血尿16例,膀胱刺激征1例,疼痛2例,无症状1例;肿瘤位于前后壁4例,顶壁16例;肿瘤直径3.0(2.0,4.8)cm;肿瘤单发18例,多发2例;行膀胱部分切除术16例,根治性膀胱切除术1例,TURBT 1例,未手术2例。非脐尿管腺癌组32例,男24例,女8例;年龄55.0(46.3,70.8)岁;有吸烟史11例;就诊原因为血尿16例,膀胱刺激征3例,排尿困难1例,疼痛7例,无症状5例;肿瘤位于前后壁17例,侧壁7例,三角区5例,顶壁3例;肿瘤直径3.6(2.0,4.5)cm;肿瘤单发23例,多发9例;行根治性膀胱切除术11例,膀胱部分切除术9例,TURBT 9例,未手术3例。3组年龄、就诊原因、肿瘤直径、肿瘤部位、手术方式差异均有统计学意义(P<0.05)。比较3组的临床病理特征和预后差异,并应用Cox比例回归风险模型分析影响预后的危险因素。结果本研究107例中,91例获得随访,总体随访率85.1%。中位随访时间26(7,48)个月,3、5年总生存率分别为54.1%和42.2%。SqCC组术后接受化疗11例,放疗3例,膀胱灌注治疗12例;术后复发10例;淋巴结转移17例;远处转移19例;pT分期pT_x期5例,pT1~pT2期36例,pT3~pT4期14例;肿瘤分化未知19例,高分化4例,中分化24例,低分化8例。脐尿管腺癌组术后接受化疗7例;术后复发3例;淋巴结转移2例;远处转移2例;pT分期pT_x期1例,pT1~pT2期16例,pT3~pT4期3例;肿瘤分化未知9例,高分化3例,中分化5例,低分化3例。非脐尿管腺癌组术后接受化疗3例,放疗1例,膀胱灌注治疗11例;术后复发10例;淋巴结转移5例;远处转移4例;pT分期pT_x期6例,pT1~pT2期21例,pT3~pT4期5例;肿瘤分化未知14例,中分化8例,低分化10例。3组术后行膀胱灌注治疗和远处转移比例的差异有统计学意义(均P<0.05)。单因素分析结果显示性别、年龄、手术方式、淋巴结转移、远处转移、pT分期、肿瘤分化、组织学类型是影响预后的危险因素(均P<0.05)。多因素分析结果显示女性(HR=2.604,P=0.032)、远处转移(HR=2.571,P=0.026)是影响患者预后的独立危险因素。结论SqCC和膀胱腺癌临床罕见,预后较差,常表现为血尿,首选手术治疗,其中SqCC和非脐尿管腺癌首选根治性膀胱切除术,脐尿管腺癌首选扩大性膀胱部分切除术。女性、远处转移是影响患者预后的独立危险因素。

Analysis of clinicopathological characteristics and prognosis of bladder squamous cell carcinoma and adenocarcinoma

Objective To explore the clinicopathological characteristics and prognostic factors of bladder squamous cell carcinoma(SqCC)and bladder adenocarcinoma.Methods A retrospective analysis of the clinical data of 107 patients with nonurothelial carcinoma of the bladder admitted to the First Affiliated Hospital of Zhengzhou University from October 2011 to January 2019 was performed.Among the 107 patients,78 were males and 29 were females(ratio 2.69∶1),and the median age of onset was 62.0 years.According to histological types,patients were divided into SqCC group,urachal adenocarcinoma group and non-urachal adenocarcinoma group.There were 55 cases in the SqCC group,including 40 males and 15 females.Their mean age was 69.0(58.0,75.0)years.14 cases had the history of smoking.The clinic manifestation included hematuria in 35 cases,bladder irritation in 13 cases,dysuria in 2 cases and pain in 5 cases.Tumors located at the anterior and posterior walls in 18 cases,at the lateral wall in 27 cases,at the triangular area in 8 cases and at the apical wall in 2 cases.The average diameter of tumor was 4.5(3.0,6.0)cm.37 cases suffered with single tumor and 18 cases suffered with multiple tumors.The surgical method was radical cystectomy in 38 cases,partial cystectomy in 4 cases,TURBT in 9 cases,interventional surgery in 2 cases,and no operation in 2 cases.There were 20 cases in the urachal adenocarcinoma group,including 14 males and 6 females;age 53.5(43.5,57.8)years;6 cases with a history of smoking.The clinic manifestation included hematuria in 16 cases,bladder irritation in 1 case,pain in 2 cases and asymptomatic in 1 case.Tumors located at anterior and posterior walls in 4 cases and at apical wall in 16.The average diameter of tumor was 3.0(2.0,4.8)cm.Single tumor was present in 18 cases,multiple tumors were present in 2 cases.The surgical method was partial cystectomy in 16 cases,radical cystectomy in 1 case,TURBT in 1 case and no operation in 2 cases.There were 32 cases in the non-urachal adenocarcinoma group,including 24 males and 8 females.Their mean age was 55.0(46.3,70.8)years.11 cases had a history of smoking.The clinic manifestation included hematuria in 16 cases,bladder irritation in 3 cases,dysuria in one case and pain in 7 cases.Tumor located at anterior and posterior walls in 17 cases,at lateral wall in 7 cases,at triangular area in 5 cases and at apical wall in 3 cases.The average diameter of tumor was 3.6(2.0,4.5)cm.23 cases suffered with single tumor,9 cases suffered with multiple tumors.The surgical method was radical cystectomy in 11 cases,partial cystectomy in 9 cases,TURBT in 9 cases,and no operation in 3 cases.The preoperative data of the three groups of tissue types were compared,the differences of age of onset,tumor diameter,tumor location,reason for treatment,operation method(P<0.05)among the 3 groups were statistically significant.The clinicopathological characteristics and prognosis of the 3 groups of tissue types were compared,and the Cox proportional regression risk model was used to analyze the clinical factors affecting the prognosis.Results 91 patients were followed up,the overall follow-up rate was 85.1%,the median follow-up time was 26(7,48)months.The 3-year and 5-year overall survival rates were 54.1%and 42.2%,respectively.In the SqCC group,11 cases received chemotherapy;3 cases received postoperative radiotherapy;12 cases received postoperative perfusion.10 cases had recurrence;17 cases had lymph node metastasis;19 cases had distant metastasis;5 cases were pT_x in pT stage,36 cases were pT1-pT2,14 cases were pT3-pT4.19 cases had unknown tumor differentiation,4 cases had well differentiated,24 cases had moderately differentiated and 8 cases had poorly differentiated.In the urachal adenocarcinoma group,7 cases received chemotherapy,3 cases had recurrence,2 cases had lymph node metastasis,2 cases had distant metastasis;1 case was pT_x in pT stage,16 cases were pT1-pT2,3 cases were pT3-pT4.9 cases had unknown tumor differentiation,3 cases had well differentiated,and 5 cases had moderately differentiated,3 cases had poorly differentiated.In the urachal adenocarcinoma group,3 cases received chemotherapy,1 case received postradiotherapy,11 cases received postoperative perfusion;10 cases had recurrence.5 cases had lymph node metastasis,4 cases had distant metastasis,6 cases were pT_x,21 cases were pT1-pT2 and 5 cases were pT3-pT4.14 cases had unknown tumor differentiation,8 cases had moderately differentiated and 10 cases had poorly differentiated.The postoperative general data of the three groups of tissue types were compared.There was statistically significant difference between whether there was postoperative perfusion and whether there was distant metastasis(all P<0.05).The univariate analysis results showed gender,age,surgical method,lymph node metastasis,distant metastasis,pT staging,tumor differentiation and histological type were risk factors that affect the prognosis(all P<0.05).Cox multivariate analysis showed that women(HR=2.604,P=0.032)and distant metastases(HR=2.571,P=0.026)were independent risk factors affecting the prognosis of patients.Conclusions SqCC and adenocarcinoma are clinically rare and have poor prognosis.They often present with hematuria.Surgical treatment is the first choice.Radical cystectomy is the first choice for SqCC and non-urachal adenocarcinoma,and extended partial cystectomy is the first choice for urachal adenocarcinoma.Female and distant metastasis are independent risk factors affecting the prognosis of patients.