单中心16年青年膀胱尿路上皮癌患者的诊治

目的：研究40岁及以下青年膀胱尿路上皮癌患者的临床表现、临床分期、病理分级、治疗及预后等情况。方法：选择 2001年1月至2016年12月北京大学第三医院泌尿外科收治的43例40岁及以下的膀胱癌患者临床资料进行回顾性分析。结果：本组病例占同期科室收治的膀胱癌患者的2.2%，男性35例，女性8例，平均年龄33岁（23~40岁）。初诊时以无痛性肉眼血尿为主要症状者27例（62.8%）， 体检发现异常者9例（20.9%），以膀胱刺激症状或排尿异常起病者7例（16.3%）。肿瘤单发者34例（79.1%），多发者9例（20.9%）,且多发者均在31~40岁亚组。根据患者临床分期采用相应的手术方式治疗。 术后病理分级：低级别乳头状尿路上皮癌29例（67.4%），高级别乳头状尿路上皮癌14例（32.6%）。Ta期31例（72.1%），T1期7例（16.3%）， T3期1例（2.3%）， T4期3例（7.0%），T1期合并Tis 1例（2.3%）。术后3例失访，另40例随访5~165个月，随访患者中有5例复发，复发率12.5%（5/40）， 平均复发时间39个月（3~105个月）， 2例患者进展，进展率5%（2/40）。多发患者组复发率33%（3/9），单发患者组复发率5.9%（2/34），两组差异具有统计学意义（P=0.000 3）。结论：青年膀胱癌的发病比例呈增长趋势， 无痛性肉眼血尿是青年膀胱癌的主要临床表现，但青年患者的下尿路刺激症状同样需警惕肿瘤的发生，术后的复发情况可能与多发病变有关。

Retrospective study of young bladder urothelial carcinoma from a single center within 16 years

Objective： To evaluate the clinical and pathological features, treatment and prognosis for bladder urothelial carcinoma in relative young patients under 40 years. Methods: A retrospective study involved a total of 43 consecutive patients of bladder urothelial carcinoma, which were under 40 years old from January 2001 to December 2016. Results: The incidence rate of bladder urothelial carcinoma in the patients under 40 years was 2.2%, and 35 males and 8 females were included. The average age was 33 years (ranging from 23 to 40 years). At initial visit, 62.8% of the patients presented with painless gross hematuria, 9 patients were discovered by routine examination, and 7 patients experienced lower urinary tract symptoms. Solitary tumor occurred in 34 cases whereas multiple carcinomas had been discovered in 9 cases，and all the 9 multiple cases were from 31-40-year-old subgroups. All the patients received proper surgical intervention according to their own clinical stages. Post-operative pathological results showed 29 low-grade urothelial carcinoma and 14 high-grade cases which included 31 Ta cases, with 7 cases of T1, 1 case of T3, and 3 cases of T4 and one case of T1 plus Tis. The total follow-up was from 5 to 165 months,3 cases were lost. The overall recurrence rate was 12.5% (5 cases from 40). One patient developed distal metastasis, one died of metastasis after 13 months, and the other three received secondary trans-urethral resection of bladder tumors. The average recurrence time was 39 months (rang-ing from 3 to 105 months). The progression rate was 5% among all the followed up patients (2 cases from 40). The recurrence rate in multiple lesions group (33%, 3/9) was significantly higher than that (5.9%, 2/34) in solitary lesion group (P=0.000 3). Conclusion: The incidence rate of bladder urothelial carcinoma in young patients under 40 years becomes increasingly higher over years. The major initial presentation is painless gross hematuria among these young patients, but lower urinary tract symptoms should also be noticed for young patients to rule out tumor. Postoperative tumor recurrence might be associated with multiple lesions, which is not related to the tumor size or pathological features.