【作者】 张莹；

【导师】 王红；

【作者基本信息】 吉林大学 ， 肿瘤学（专业学位）， 2024， 硕士

【摘要】 目的:目前,关于不同病理类型是否与膀胱癌(Bladder Cancer,BC)的预后相关,尚缺乏询证医学证据。尤其是鳞状细胞癌和腺癌等罕见的病理类型与移行细胞癌之间的预后差异仍无定论。本研究旨在通过SEER数据库明确膀胱癌的独立预后因素,并深入分析病理类型对膀胱癌患者总生存期(Overall Survival,OS)的影响,为不同病理类型的膀胱癌患者的个体化治疗提供理论依据。材料和方法:利用SEER数据库(Surveillance,Epidemiology,and End Results),采用回顾性分析的方法,获取2010—2020年间有完整随访时间的膀胱癌患者的相关数据。使用R Studio软件(4.3.2版本)进行数据的计算和分析。利用单因素和多因素Cox比例风险模型明确影响膀胱癌的独立预后因素,采用Kaplan-Meier生存分析比较不同病理类型组患者的生存差异,使用Log-rank法检验不同生存曲线是否有差异。利用单因素和多因素Cox比例风险模型分析不同病理类型与总生存期(OS)之间的关系及病理类型是否与膀胱癌的预后相关,用风险比(hazard ratios,HR)和95%可信区间表示,P<0.05认为差异有统计学意义。结果:在本研究最终纳入的188811例膀胱癌患者中,单因素和多因素Cox回归分析表明年龄、性别、种族、原发部位、组织学分级、SEER分期、TNM分期和是否手术、放疗、化疗与膀胱癌患者预后存在统计学差异(P<0.05)。按病理类型分组如下:乳头状移行细胞癌共181645例(94.15%),鳞状细胞癌为2667例(1.41%),腺癌组为1598例(0.85%),其他未分型及未知病理类型的共2901例。多因素Cox回归分析结果提示,在总人群中不同病理类型膀胱癌患者预后之间存在统计学差异。与乳头状移行细胞癌相比,鳞状细胞癌HR=1.765,(95%CI=1.684–1.850,P<0.001)、腺癌HR=1.141,(95%CI=1.069–1.218,P<0.001)。据Kaplan-Meier生存曲线可知,乳头状移行细胞癌的预后最好,乳头状移行细胞癌、腺癌、鳞状细胞癌的三年生存率分别为70.03%、44.68%、32.3%,五年生存率分别为60.12%、35.32%、27.47%。在NMIBC组得到了相似的结果,但在MIBC组,不论是否存在远处转移,多因素Cox回归分析结果提示与乳头状移行细胞癌相比,腺癌未见显著统计学差异(P>0.05),而鳞状细胞癌的死亡风险是乳头状移行细胞癌的1.502倍(HR:1.502,95%CI:1.416-1.594,P<0.001)。结论:本研究结果表明,在不同病理类型的膀胱癌患者中,其预后存在差异。在NMIBC组患者中,鳞状细胞癌和腺癌的膀胱癌患者的生存率低于乳头状移行细胞癌,乳头状移行细胞癌的生存率最好,其次为腺癌和鳞状细胞癌。在MIBC组中,乳头状移行细胞癌和腺癌患者预后未见明显差别,鳞状细胞癌患者预后最差。多因素Cox回归分析结果表明年龄、性别、种族、原发部位、组织学分级、SEER分期、TNM分期和是否手术、放疗、化疗是影响膀胱癌总生存期的独立预后因素。更多还原

【Abstract】 Objective:Currently,there is a lack of evidence-based medical proof regarding the association between various pathological subtypes and the prognosis of Bladder Cancer(BC).Specifically,the prognostic differences between rarer pathological types such as squamous cell carcinoma and adenocarcinoma in comparison to transitional cell carcinoma remain unresolved.The purpose of this study is to identify the independent prognostic factors affecting bladder cancer through the Surveillance,Epidemiology,and End Results(SEER)database.Furthermore,this research aims to thoroughly analyze the impact of pathological subtypes on the overall survival(OS)of bladder cancer patients,providing a theoretical basis for personalized treatment strategies for patients with different pathological subtypes of bladder cancer.Materials and Methods:Employing a retrospective analysis of the SEER database(Surveillance,Epidemiology,and End Results),we collated relevant data of bladder cancer patients who were comprehensively followed up between 2010 and 2020.We utilized R Studio software(version 4.3.2)for data computation and analysis.Independent prognostic factors affecting bladder cancer were identified through univariate and multivariate Cox proportional hazards models.Survival disparities across different pathological types were compared using the Kaplan-Meier survival analysis.The log-rank test was implemented to assess the differences between survival curves.To investigate the relationship between different pathological types and overall survival(OS),univariate and multivariate Cox proportional hazards models were employed.Independent prognostic significance of pathological types in bladder cancer was assessed,with hazard ratios(HR)and 95% confidence intervals reported.A p-value of less than 0.05 was considered statistically significant.Results:In this study,which ultimately included 188,811 bladder cancer patients,both univariate and multivariate Cox regression analyses indicated that age,sex,race,primary site,histological grade,SEER stage,TNM stage,and whether surgery,radiation therapy,or chemotherapy was received,showed statistically significant differences in prognosis among bladder cancer patients(P<0.05).The patients were categorized into pathological types as follows: 181,645 cases(94.15%)were papillary urothelial carcinoma,2,667 cases(1.41%)were squamous cell carcinoma,1,598 cases(0.85%)were adenocarcinoma,and 2,901 cases consisted of other unspecified and unknown pathological types.Multivariate Cox regression analysis suggested that there were statistically significant differences in the prognosis among bladder cancer patients with different pathological types within the overall population.Compared to papillary urothelial carcinoma,the hazard ratio(HR)for squamous cell carcinoma was 1.765(95% CI=1.684–1.850,P<0.001),and for adenocarcinoma,HR was 1.141(95% CI=1.069–1.218,P<0.001).According to the Kaplan-Meier survival curves,papillary urothelial carcinoma had the best prognosis.The three-year survival rates for papillary urothelial carcinoma,adenocarcinoma and squamous cell carcinoma were70.03%,44.68% and 32.3%,,respectively,while the five-year survival rates were60.12%,35.32%,27.47%,respectively.Similar results were obtained in the NMIBC group,but in the MIBC group,regardless of the presence of distant metastasis,multivariate Cox regression analysis indicated that compared to papillary urothelial carcinoma,adenocarcinoma did not show a statistically significant difference(P>0.05),whereas the risk of death for squamous cell carcinoma was 1.502 times that of papillary urothelial carcinoma(HR: 1.502,95% CI: 1.416-1.594,P<0.001).Conclusion:The findings of this research indicate that prognostic disparities exist among patients with bladder cancer across different pathological types.In the cohort of patients with Non-Muscle Invasive Bladder Cancer(NMIBC),those diagnosed with squamous cell carcinoma and adenocarcinoma exhibited lower survival rates compared to patients with papillary urothelial carcinoma,which demonstrated the most favorable survival outcomes,followed by adenocarcinoma and squamous cell carcinoma,respectively.Within the Muscle-Invasive Bladder Cancer(MIBC)groups,no significant prognostic differences were observed between patients with papillary urothelial carcinoma and adenocarcinoma,while those with squamous cell carcinoma presented the least favorable prognosis.Multivariate Cox regression analysis revealed that age,gender,race,primary site,histologic grade,SEER stage,TNM stage,and whether the patient underwent surgery,radiotherapy,or chemotherapy were independent prognostic factors affecting the overall survival of bladder cancer patients.更多还原