可切除膀胱肉瘤样癌患者临床病理特征及预后影响因素分析

黄世旺; 贾凯鹏; 沈冲; 陈惠童; 张哲; 吴周亮; 郄云凯; 郭嘉宁; 胡海龙

doi:10.12182/20240960102

可切除膀胱肉瘤样癌患者临床病理特征及预后影响因素分析

Analysis of Clinicopathological Characteristics and Factors Affecting the Prognosis of Patients With Resectable Sarcomatoid Carcinoma of the Bladder

摘要

摘要:
目的探究可切除膀胱肉瘤样癌（sarcomatoid carcinoma of the bladder, SCB）患者的临床病理特征及其预后影响因素。
方法回顾性分析2008年9月–2023年12月天津医科大学第二医院收治的可切除SCB患者的临床病理资料。根据手术方式分为保留膀胱手术（bladder-preserving surgery, BPS）组和根治性膀胱切除术（radical cystectomy, RC）组。采用Kaplan-Meier曲线评估两组患者总生存期，并采用Cox回归模型分析影响生存的危险因素。
结果共纳入77例可切除SCB患者，其中35例（45.5%）BPS组，42例（54.5%）RC组。Ki-67表达≥30%占91.7%，细胞角蛋白（cytokeratin, CK）阳性92.2%，波形蛋白（vimentin）阳性98.1%，人表皮生长因子受体2（human epidermal growth factor receptor 2, Her-2）评分为“0”和“1+”的比例分别为62.5%（5/8）和37.5%（3/8）。中位随访时间23.2个月(范围：0.4～164.7个月)，BPS组和RC组的1年、3年和5年生存率分别为76.2% vs. 84.9%、46.7% vs. 61.1%、35.6% vs.43.2%。多因素Cox回归分析显示，RC组中年龄≥75岁〔风险比（hazard ratio, HR）=3.836, 95%置信区间（confidence interval, CI）: 1.168～12.595, P=0.027〕、肿瘤多发（HR=3.439, 95%CI: 1.235～9.574, P=0.018）以及未接受术后辅助治疗（HR=3.164, 95%CI: 1.015～9.862, P=0.047）是影响生存的独立危险因素。BPS组中，女性性别是影响生存的独立危险因素（HR=3.601, 95%CI: 1.200～10.804, P=0.022）。
结论 Ki-67、CK和vimentin在可切除SCB患者中显著高表达，Her-2则呈零表达或低表达。在RC患者中，肿瘤多发、年龄≥75岁及未接受术后辅助治疗是影响总生存期的独立危险因素，女性性别是影响BPS患者预后的独立危险因素。

Abstract:
Objective To investigate the clinicopathological characteristics and the factors affecting the prognosis of patients with resectable sarcomatoid carcinoma of the bladder (SCB).
Methods A retrospective analysis was conducted with the clinical data of patients with resectable SCB treated at the Second Hospital of Tianjin Medical University between September 2008 and December 2023. The patients were divided into two groups, a bladder-preserving surgery (BPS) group and a radical cystectomy (RC) group, according to the specific surgical approach used for each patient. Kaplan-Meier survival curves were used to evaluate overall survival (OS) in both groups, and Cox regression models were employed to identify risk factors affecting survival.
Results A total of 77 patients with resectable SCB were included. Among them, 35 patients (45.5%) underwent BPS, while 42 patients (54.5%) underwent RC. Ki-67 expression≥30% was observed in 91.7% of the patients. A total of 92.2% of the patients was tested positive for cytokeratin (CK) and 98.1% for vimentin. In addition, 62.5% and 37.5% of patients had the human epidermal growth factor receptor 2 (Her-2) scores of 0 and 1+, respectively. The median follow-up time was 23.2 months (ranging from 0.4 to 164.7 months). The 1-year, 3-year, and 5-year survival rates for the BPS group and the RC group were as follows, 76.2% vs. 84.9%, 46.7% vs. 61.1%, and 35.6% vs. 43.2%, respectively. Multivariate Cox regression analysis revealed that in the RC group, age≥75 years old (hazard ratio HR=3.836, 95% confidence interval CI: 1.168-12.595, P=0.027), tumor multiplicity (HR=3.439, 95% CI: 1.235-9.574, P=0.018), and lack of adjuvant therapy (HR=3.164, 95% CI: 1.015-9.862, P=0.047) were independent risk factors affecting survival. In the BPS group, female sex was identified as an independent risk factor for survival (HR=3.601, 95% CI: 1.200-10.804, P=0.022).
Conclusion Ki-67, CK, and vimentin are significantly overexpressed in SCB patients, while Her-2 is either unexpressed or expressed at low levels. In the RC group, tumor multiplicity, age ≥75 years, and lack of postoperative adjuvant therapy are independent risk factors for overall survival. Female sex is an independent risk factor affecting prognosis in the BPS group.

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