肌层浸润性膀胱癌合并中高危前列腺癌患者的预后因素

doi:10.19723/j.issn.1671-167X.2024.04.006

摘要/Abstract

摘要：

目的: 探究影响肌层浸润性膀胱癌(muscle-invasive bladder cancer, MIBC)合并中高危前列腺癌患者全因死亡结局的预后因素。方法: 回顾性分析2012年1月至2023年10月北京大学第三医院收治的MIBC合并中高危前列腺癌患者临床资料，随访并记录所有患者的全因死亡结局发生时间，并以其作为预后研究的结局事件。采用单因素及多因素Cox比例风险回归分析模型筛选MIBC合并中高危前列腺癌患者预后的独立影响因子，对于重要的影响因素(膀胱癌病理T分期、M分期、神经侵犯)，绘制多因素Cox回归调整混杂因素前后的生存曲线。结果: 共纳入32例患者，平均年龄(72.5±6.6)岁，中位术前总前列腺特异性抗原(total prostate specific antigen，tPSA)6.68(2.47，6.84) μg/L，平均术前血肌酐(95±36) μmol/L，中位生存期为65个月。绝大多数(87.5%)患者膀胱癌病理分级为高级别，53.1%患者可见淋巴管侵犯，31.3%患者可见神经侵犯。25.0%的病例可见膀胱癌累及前列腺，手术软组织切缘阳性率为37. 5%。Cox多因素分析结果提示术前血肌酐水平(HR=1.02，95%CI：1.01~1.04)、膀胱癌病理分期T3(HR=11.58，95%CI：1.38~97.36)和T4(HR=19.53，95%CI：4.26~89.52)、膀胱癌转移(HR=9.44，95%CI：1.26~70.49)、膀胱癌神经侵犯(HR=6.26，95%CI：1.39~28.27)是影响患者预后的独立因素(P < 0.05)。调整混杂因素后的生存曲线与Log-rank检验结果提示膀胱癌病理分期T3、T4、M1和神经侵犯为影响患者生存预后的不良因素(P＜0.05)。结论: MIBC合并中高危前列腺癌患者整体存在预后较差的趋势; 术前血肌酐高、膀胱癌病理分期T3或T4、膀胱癌转移、膀胱癌神经侵犯是MIBC合并中高危前列腺癌患者的不良预后因素。

关键词: 膀胱肿瘤, 肿瘤浸润, 前列腺肿瘤, 肿瘤，多原发性, 预后

Abstract:

Objective: To investigate the prognostic factors for all-cause mortality in patients with muscle-invasive bladder cancer (MIBC) with intermediate-to-high-risk primary prostate cancer. Methods: From January 2012 to October 2023, the clinical data of the patients with MIBC with intermediate-to-high-risk primary prostate cancer in Peking University Third Hospital were retrospectively analyzed. All the patients were monitored and the occurrence of all-cause death was documented as the outcome event in the prognostic study. Univariate and multivariate Cox proportional risk regression analysis models were implemented to search for independent influences on the prognosis of patients. For significant influencing factors (pathological T stage, M stage and perineural invasion of bladder cancer), survival curves were plotted before and after multifactorial Cox regression adjusting for confounding factors. Results: A total of 32 patients were included in this study. The mean age was (72.5±6.6) years; the median preoperative total prostate specific antigen (tPSA) was 6.68 (2.47, 6.84) μg/L; the mean preoperative creatinine was (95±36) μmol/L, and the median survival time was 65 months. The majority of the patients (87.5%) had high-grade bladder cancer, 53.1% had lymphatic invasion, and 31.3% had perineural invasion. Prostate involvement was observed in 25.0% of the cases, and the positive rate of soft-tissue surgical margin was 37.5%. Multivariate Cox analysis revealed that preoperative creatinine level (HR=1.02, 95%CI: 1.01-1.04), pathological stage of bladder cancer T3 (HR=11.58, 95%CI: 1.38-97.36) and T4 (HR=19.53, 95%CI: 4.26-89.52) metastasis of bladder cancer (HR=9.44, 95%CI: 1.26-70.49) and perineural invasion of bladder cancer (HR=6.26, 95%CI: 1.39-28.27) were independent prognostic factors (P < 0.05). Survival curves with Log-rank test after adjusting for confounding factors demonstrated that bladder cancer pathology T3, T4, M1, and perineural invasion were unfavorable factors affecting the patients' survival prognosis (P < 0.05). Conclusion: Patients with MIBC with intermediate-to-high risk primary prostate cancer generally portends a poor prognosis. High preoperative serum creatinine, T3 or T4 pathological stage of bladder cancer, metastasis of bladder cancer and bladder cancer perineural invasion are poor prognostic factors for patients with MIBC with intermediate-to-high risk primary prostate cancer.

Key words: Urinary bladder neoplasms, Neoplasm invasiveness, Prostatic neoplasms, Neoplasms, multiple primary, Prognosis

中图分类号:

R737.1

欧俊永,倪坤明,马潞林,王国良,颜野,杨斌,李庚午,宋昊东,陆敏,叶剑飞,张树栋. 肌层浸润性膀胱癌合并中高危前列腺癌患者的预后因素[J]. 北京大学学报（医学版）, 2024, 56(4): 582-588.

Junyong OU,Kunming NI,Lulin MA,Guoliang WANG,Ye YAN,Bin YANG,Gengwu LI,Haodong SONG,Min LU,Jianfei YE,Shudong ZHANG. Prognostic factors of patients with muscle invasive bladder cancer with intermediate-to-high risk prostate cancer[J]. Journal of Peking University (Health Sciences), 2024, 56(4): 582-588.

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参考文献 14

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Characteristic	Data	Characteristic	Data
Age/years	72.5±6.6	Metastasis (BCa)
tPSA/(μg/L)	6.68 (2.47, 6.84)	No	27 (84.4)
BMI/(kg/m²)	23.8±3.2	Yes	5 (15.6)
Preoperative hemoglobin/(g/L)	130±22	LVI (BCa)
Preoperative creatinine/(μmol/L)	95±36	LVI-	15 (46.9)
Comorbidity^a		LVI+	17 (53.1)
0	12 (37.5)	PNI (BCa)
1	11 (34.4)	PNI-	22 (68.8)
2	5 (15.6)	PNI+	10 (31.3)
≥3	4 (12.5)	STSM (BCa)
History of smoking		Margin-	20 (62.5)
No	23 (71.9)	Margin+	12 (37.5)
Yes	9 (28.1)	BCa involved prostate
History of alcohol consumption		Involve-	24 (75.0)
No	25 (78.1)	Involve+	8 (25.0)
Yes	7 (21.9)	Gleason score (PCa)
Preoperative TURP		3+4	18 (56.3)
No	19 (59.4)	4+3	8 (25.0)
Yes	13 (40.6)	≥8	6 (18.8)
Neoadjuvant treatment		pT (PCa)
No	15 (46.9)	≤ pT2	28 (87.5)
Yes	17 (53.1)	≥ pT3	4 (12.5)
Histology		PNI (PCa)
Urothelial carcinoma	30 (93.8)	PNI-	28 (87.5)
Small cell carcinoma	1 (3.1)	PNI+	4 (12.5)
Adenocarcinoma	1 (3.1)	Margin (PCa)
Grade (BCa)		Margin-	7 (21.9)
Low grade	4 (12.5)	Margin+	25 (78.1)
High grade	28 (87.5)	Procedure for radical cystectomy
pT (BCa)		Laparoscopy	24 (75.0)
pT2	20 (62.5)	Robot-assisted laparoscopy	8 (25.0)
pT3	3 (9.4)	Urinary flow diversion pattern
pT4	9 (28.1)	Bricker bladder	12 (37.5)
pN (BCa)		Studur bladder	3 (9.4)
pN-	26 (81.3)	Cutaneous terminal ureterostomy	17 (53.1)
pN+	6 (18.8)

Characteristic	HR	95%CI	P
Age	1.04	0.96-1.13	0.310
tPSA	1.00	0.96-1.04	0.934
BMI	0.96	0.80-1.16	0.694
Preoperative hemoglobin	0.97	0.95-1.00	0.043
Preoperative creatinine	1.02	1.01-1.04	0.004
Grade (BCa)
Low grade
High grade	NA	NA	NA
pT (BCa)
pT2
pT3	3.15	0.32-31.13	0.326
pT4	10.23	2.34-44.70	0.002
pN (BCa)
pN-
pN+	2.33	0.59-9.20	0.226
Metastasis (BCa)
No
Yes	1.26	0.26-6.01	0.771
LVI (BCa)
LVI-
LVI+	4.24	0.90-20.04	0.068
PNI (BCa)
PNI-
PNI+	4.45	1.25-15.92	0.022
STSM (BCa)
Margin-
Margin+	7.43	1.79-30.87	0.006
BCa involved prostate
Involve-
Involve+	3.33	0.92-12.03	0.067
Gleason score (PCa)
3+4
4+3	0.91	0.22-3.74	0.893
≥8	0.25	0.03-2.44	0.234
pT (PCa)
≤pT2
≥pT3	0.60	0.08-4.76	0.630
PNI (PCa)
PNI-
PNI+	NA	NA	NA
Margin (PCa)
Margin-
Margin+	0.40	0.10-1.62	0.198

Characteristic	HR	95%CI	P
Preoperative hemoglobin	1.00	0.97-1.03	0.928
Preoperative creatinine	1.02	1.01-1.04	0.006
pT (BCa)
pT2
pT3	11.58	1.38-97.36	0.024
pT4	19.53	4.26-89.52	< 0.001
pN (BCa)
pN-
pN+	0.86	0.16-4.78	0.867
Metastasis (BCa)
No
Yes	9.44	1.26-70.49	0.029
LVI (BCa)
LVI-
LVI+	0.32	0.06-1.78	0.194
PNI (BCa)
PNI-
PNI+	6.26	1.39-28.27	0.017
STSM (BCa)
Margin-
Margin+	1.00	0.19-5.26	>0.999