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目的探讨影响浸润性膀胱癌患者根治术后长期生存的预后因素。方法回顾性分析1991-2004年178例浸润性膀胱癌患者资料,选择12个对预后可能产生影响的因素及尿流改道方式、新辅助化疗等特征性因素进行Cox回归分析。计算患者的预后指数(PI),将患者分组计算不同个体的期望生存曲线。结果影响浸润性膀胱癌患者长期生存的因素分别为分期(RR=1．982,P=0．000)、分级(RR=1．978,P=0．042)、淋巴结转移(RR=2．142,P=0．048)、原位癌(RR=6．177,P=0．000)、肿瘤形状(RR=0．416,P=0．003)、病理类型(RR=2．228,P=0．032)、肿瘤数目(RR= 1．820,P=0．035)、患者年龄(RR=0．672,P=0．025)及新辅助化疗(RR=0．257,P=0．016)。根据预后指数的百分位数将患者分为低危组、中危组和高危组3个预后组,3组患者中位生存时间分别为42．5、22．5、7．0个月,3组患者预后两两比较差异有统计学意义(P＜0．01)。结论新辅助化疗、分期、分级、淋巴结转移、原位癌、肿瘤形状、病理类型、肿瘤数目、患者年龄是影响浸润性膀胱癌患者生存期的预后因素,PI值可用于预测浸润性膀胱癌患者的预后。
Objective To investigate the prognostic factors of long-term survival after radical surgery in patients with invasive bladder cancer. Methods The data of 178 patients with invasive bladder cancer from 1991 to 2004 were retrospectively analyzed. Cox regression analysis was performed on 12 factors that may have an impact on the prognosis and the characteristics of urinary diversion and neoadjuvant chemotherapy. The patient’s prognostic index (PI) was calculated and the patients were grouped to calculate the expected survival curves for different individuals. Results The factors influencing the long-term survival of invasive bladder cancer were stage (RR = 1.982, P = 0.000), grade (RR = 1.978, P = 0.042) and lymph node metastasis (RR = (RR = 6.177, P = 0.000), pathological type (RR = 2.168, P = 0.048) , The number of tumors (RR = 1.820, P = 0.035), patient’s age (RR = 0.672, P = 0.025) and neoadjuvant chemotherapy (RR = 0.257, P = 0.016). The patients were divided into low-risk group, moderate-risk group and high-risk group according to the percentile of the prognostic index. The median survival time of the three groups were 42.5,22.5,7.0 months, The prognosis of the three groups was significantly different (P <0.01). Conclusions Neoadjuvant chemotherapy, staging, grading, lymph node metastasis, carcinoma in situ, tumor shape, pathological type, tumor number and patient’s age are the prognostic factors affecting the survival of patients with invasive bladder cancer. The PI value can be used to predict the prognosis of patients with invasive bladder cancer The prognosis.