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膀胱小细胞癌临床病理特征及围手术期治疗效果观察

Clinicopathological Features and Outcomes of Perioperative Treatment for Small Cell Carcinoma of the Bladder

  • 摘要:
    目的  膀胱小细胞癌(small cell carcinoma of bladder, SCCB)是一种罕见的膀胱恶性肿瘤,本研究拟探索其临床病理特征和预后因素,同时探讨围手术期治疗的疗效。
    方法  收集2016年1月–2024年1月四川大学华西医院收治的SCCB患者的临床资料。总结该肿瘤的临床病理特征,分析生存结果和预后因素,探索围手术期治疗对改善预后的作用。
    结果  共纳入31例SCCB病例,其临床病理特征包括:临床分期晚,所有病例T分期均在T2以上,初诊病例有23%发现远处转移;合并其他组织学类型比例高,其中96%合并尿路上皮癌。患者预后较差,中位生存时间为12.0个月,1年总生存(overall survival, OS)率57.9%,3年OS率27.6%。广泛期SCCB患者中位生存时间(4.4个月)较局限期患者中位生存时间短(17.0个月),差异有统计学意义(P<0.05)。局限期SCCB中,接受根治性膀胱切除术(radical cystectomy, RC)患者和未接受RC患者中位OS为19.9个月和15.2个月,差异有统计学意义(P<0.05)。围手术治疗联合RC组总生存时间长于单纯手术组(P<0.05),其中接受新辅助治疗患者总生存时间长于未接收新辅助治疗患者(P<0.05)。亚组分析显示,新辅助治疗有反应的患者无病生存时间和总生存时间均长于新辅助治疗无反应患者(P<0.05)。淋巴结转移为独立预后不良因素〔风险比(hazard ratio, HR)=15.21,95%置信区间(confidence interval, CI):1.732~133.912,P=0.014〕,根治性术前接受新辅助治疗是独立保护因素,对比接受初始手术能显著降低患者的死亡风险(HR=0.03,95%CI:0.001~0.724,P=0.031)。
    结论  对于局限期SCCB患者,根治性手术是延长生存期的有效治疗方法,联合新辅助治疗可进一步提高其生存率。

     

    Abstract:
    Objective Small cell carcinoma of the bladder (SCCB) is a rare malignant tumor of the bladder. This study aims to explore its clinicopathological features and prognostic factors and to explore the role of perioperative treatment methods.
    Methods The clinical data of SCCB patients admitted to West China Hospital, Sichuan University over 8 years from January 2016 to January 2024 were collected. The clinicopathological features of SCCB were summarized. The survival outcomes and prognostic factors were analyzed. The effect of perioperative treatment on the improvement in prognosis was explored.
    Results A total of 31 confirmed cases of SCCB were enrolled. We observed a number of clinicopathologic features. All cases had advanced clinical staging, with the T staging status being above T2 in all cases, and distant metastasis was found in 23% of the newly diagnosed cases. A high proportion of the SCCB cases were combined with other histologic types, with 96% showing combination with urothelial carcinoma (UC). The SCCB patients had a poor prognosis, presenting a median survival of 12 months, 1-year overall survival (OS) of 57.9%, and 3-year OS of 27.6%. Patients with extensive-stage SCCB had a significantly worse prognosis than those with limited-stage SCCB did (median OS time of 17.0 months vs. 4.4 months, P<0.05). In limited-stage SCCB, the median OS of patients who underwent radical cystectomy (RC) was 19.9 months, while that of the patients who did not undergo RC was 15.2 months (P<0.05). The OS of patients who received perioperative therapy in combination with RC had longer OS than those who received only RC did (P<0.05). Among these, patients recevied neoadjuvant therapy (NAT) had a significantly longer OS than patients who didn't receive NAT (P<0.05). Subgroup analysis revealed that patients who were responsive to neoadjuvant therapy had longer disease-free survival and longer OS than those who were not responsive did (P<0.05). Lymph node metastasis was an independent factor of poor prognosis (hazard ratio HR=15.21, 95% confidence interval CI: 1.732-133.912, P=0.014). NAT prior to RS was an independent protective factor, significantly reducing the risk of death compared with RC alone (HR=0.03, 95% CI: 0.001-0.724, P=0.031).
    Conclusion RC is an effective treatment that prolongs the survival of patients with limited-stage SCCB. RS combined with NAT can further improve their survival.

     

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