J Urol:根治性膀胱癌切除术后复发尿道癌的风险因素及预后

2021-05-27 Nebula MedSci原创

尿路上皮癌(UC)被归类为一种“场变”疾病,举例:膀胱癌患者治疗后还有发生膀胱外尿路上皮肿瘤的风险,包括上尿路癌症和尿道癌复发。但是,接受根治性膀胱切除术(RC)的患者尿道癌复

尿路上皮癌(UC)被归类为一种“场变”疾病,举例:膀胱癌患者治疗后还有发生膀胱外尿路上皮肿瘤的风险,包括上尿路癌症和尿道癌复发。但是,接受根治性膀胱切除术(RC)的患者尿道癌复发是一个相对罕见的事件,报道发生率约3-6%。此外,尿道癌复发的部位对预后的意义不同。

迄今为止,关于尿道癌复发的数据受限于研究样本量少和随访时间短而匮乏。该研究旨在评估尿道癌复发患者的危险因素以及癌症特异性生存期 (CSS) 和总生存期 (OS)。

采用Cox比例风险回归评估尿道癌复发的危险因素。采用Kaplan-Meier和Cox模型评估尿道癌复发和CSS/OS之间的关系,并比较有症状和无症状的尿道癌复发后的结果。

该研究共纳入了1980-2018年期间接受根治性膀胱切除术的2930例患者,中位术后随访7.1年 (IQR 2.8-13.1年),其中144例 (4.9%) 在随访过程中被诊断为尿道癌复发。

有无复发患者的CSS和总生存期

原位癌 (HR 1.98,95% CI 1.30-3.04)、多灶性病灶 (HR 1.59,95% CI 1.07-2.36) 和根治性膀胱切除术时存在前列腺尿道受累 (HR 3.01,95% CI 1.98-4.57) 与尿道癌复发风险增加有关。尿道癌复发与CSS (HR 7.30,95% CI 5.46-9.76) 和OS (HR 1.86,95% CI 1.54-2.24)缩短相关。

有无症状的复发患者的CSS和总生存期

在144例尿道癌复发患者中,有63例患者根据症状被诊断为尿道癌复发,有104例尿道癌复发患者接受了输尿管切除术。有症状的尿道癌复发患者在输尿管切除术中具有较高的肿瘤分期 (pT2期及更高:13.1% vs 3.1%,p=0.007),而无症状的尿道癌复发患者的中位CSS (12.1 vs 6.1年) 和OS (8.30 vs 4.82年) 相对更长(两者p=0.05)。

总体上,原位癌、多灶性病灶和前列腺尿道受累是根治性膀胱切除术后尿道癌复发的病理危险因素。有症状的尿道癌复发患者的肿瘤分期一般较高,预后较差。

原始出处:

Khanna Abhinav,Zganjar Andrew,Lyon Timothy et al. A Contemporary Analysis of Urethral Recurrence following Radical Cystectomy.[J] .J Urol, 2021, undefined: 101097JU0000000000001842.

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    2022-02-12 lifestar
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    2021-05-28 留走人康

    膀胱癌真怪,明明是免疫敏感性肿瘤,为什么PD-1治疗效果不好呢?难道靶点不对?将来CD47会不会有效

    0

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