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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (4): 582-588. doi: 10.19723/j.issn.1671-167X.2024.04.006

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Prognostic factors of patients with muscle invasive bladder cancer with intermediate-to-high risk prostate cancer

Junyong OU1,Kunming NI2,Lulin MA1,Guoliang WANG1,Ye YAN1,Bin YANG1,Gengwu LI1,Haodong SONG1,Min LU2,Jianfei YE1,*(),Shudong ZHANG1,*()   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Pathology, Peking University Third Hospital, Beijing 100191, China
  • Received:2024-03-18 Online:2024-08-18 Published:2024-07-23
  • Contact: Jianfei YE,Shudong ZHANG E-mail:jamesyeh@126.com;zhangshudong@bjmu.edu.cn

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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

CLC Number: 

  • R737.1

Table 1

Clinicopathologic features of patients with muscle invasive bladder cancer with intermediate-to-high risk primary prostate cancer"

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)
Comorbiditya   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)

Table 2

Univariate analysis of influencing factor for 32 patients with muscle invasive bladder cancer with intermediate-to-high risk primary prostate cancer"

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

Table 3

Multivariate analysis of influencing factors for 32 patients with muscle invasive bladder cancer with intermediate-to-high risk primary prostate cancer (Cox regression)"

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

Figure 1

Survival curve of 32 muscle invasive patients with bladder cancer with intermediate-to-high risk primary prostate cancer A and B show survival curves of bladder cancer pathological T stage before and after adjusting for confounding factors, respectively; C and D show survival curves of bladder cancer pathological M stage before and after adjusting for confounding factors, respectively; E and F show survival curves of bladder cancer with perineural invasion before and after adjusting for confounding factors, respectively. Mets, metastasis; LVI, lymphovascular invasion."

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