探討膀胱尿路上皮癌的預後因子

Identify Critical Prognostic Factors in Urinary Bladder Urothelial Carcinoma

膀胱癌(bladder cancer)為泌尿道腫瘤中最常見的癌症，其診斷及治療已是現代醫學及公共衛生上不容小覷的問題。因此我們急切需要較簡便且能準確的預測膀胱癌病患，經手術切除後，其存活跟復發及轉移時間的指標。自1998年至2005年，收集來自於奇美醫院，經診斷為膀胱尿路上皮癌，並接受根治性手術的病患，共269位。利用臨床參數比較各組間病患腫瘤相關的存活時間。統計方法以Kapaln-Meier estimate、Log-rank test或Wilcoxon test、Cox 比例風險模型來進行多變量分析找出對膀胱癌病患存活有影響的因子。以腫瘤相關的存活時間來看，較高的T分期、淋巴結侵犯、組織學分期、較低的腫瘤乳突化、非結節狀的侵犯方式、有淋巴或血管的侵犯、有神經的侵犯及較高的高倍數下有絲分裂，有比較短的腫瘤相關存活時間。在Cox 比例風險模型，發現僅有T分期、高倍數下有絲分裂的程度及年齡是腫瘤相關存活時間的獨立預後因子。以無病的存活時間來看，檢體邊緣未切除乾淨、高的組織學分期、非結節狀的侵犯方式等，有比較短的無病存活時間。在Cox比例風險模型，發現檢體邊緣是否切除乾淨及組織學分級是無病存活時間的獨立預後因子，並達到顯著的意義。我們找出影響膀胱尿路上皮癌的病患存活的因子，有價值提供臨床醫師作為治療參考。

Bladder cancer (BC) is the one of the most common cancers worldwide. Currently, the challenge to the management of BC is the lack of an ideal prognostic model. Accordingly, it is highly desirable to develop a clinicopathological prognostic system to aid the determination of treatment strategies for BC. We retrospectively reviewed the records of 269 patients with urothelial carcinoma of the bladder after surgical resection seen at a medical center between 1998 and 2005. We compared the disease-free survival and cancer-specific survival time of patients with their clinical parameters. Positive surgical margin, higher histological grade, adverse invasion pattern, as well as higher mitotic activity significantly predicted disease-free survival. However, only positive margin and histological grade remained prognostically independent. Furthermore, numerous factors including increment of pT status, nodal metastasis, higher histological grade, less papillary component, adverse invasion pattern, the presence of lympho-vascular, perineurial invasion, and higher mitotic activity significantly predicted inferior cancer-specific survival. In the multivariate analysis, the increment of pT status, along with higher mitotic activity, and patient age significantly predicted inferior outcome. We have identified numerous significant prognosticators to identify patients at higher risk of disease relapse and provide further information to adjust clinical management