Prognostic Risk Prediction of Bladder Cancer Patients Regarding the Tumor-Node-Metastasis Staging System and Tumor Infiltration

doi:10.21203/rs.3.rs-3093486/v1

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Research Article

Prognostic Risk Prediction of Bladder Cancer Patients Regarding the Tumor-Node-Metastasis Staging System and Tumor Infiltration

https://doi.org/10.21203/rs.3.rs-3093486/v1

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Objective

The clinical stage and pathological grade of bladder tumors are the most valuable parameters to judge the prognosis of bladder tumors. To explore the predictive value of tumor-node-metastasis (TNM) stage and tumor invasion degree on the prognostic risk of bladder cancer (BC) patients,

Methods

90 cases of BC patients were selected as the research objects. Patient age, disease history, tumor metastasis, TNM stage, and tumor differentiation degree (TDD) were collected, and the influencing factors of patient prognosis were analyzed. In addition, the prognosis and urodynamic status of patients with different TNM stages were compared.

Results

ccording to the results of multiple regression analysis, the TDD, hydronephrosis, occurrence of lymph node metastasis (LNM), and TNM stage were independent prognostic factors of BC patients. The operation time of T3 and T4 patients (133.02 ± 9.72 min, 132.18 ± 10.08 min) was substantially longer than that of T1 and T2 patients (126.38 ± 9.41 min, 127.21 ± 10.28 min) (P < 0.05). The maximum urinary flow rates of patients in the T1, T2, T3, and T4 stages were 15.12 ± 1.79 mL/s, 14.18 ± 1.65 mL/s, 12.03 ± 1.87 mL/s, and 11.76 ± 2.01 mL/s, respectively. The maximum urinary velocity of T3 and T4 patients was notably inferior to that of T1 and T2 patients (P < 0.05), and T2 stage was notably inferior to T1 stage (P < 0.05). The residual urine volumes of patients in the T1, T2, T3, and T4 stages were 27.23 ± 6.78 mL, 27.08 ± 6.54 mL, 42.37 ± 7.02 mL, and 47.54 ± 6.69 mL, respectively. The residual urine volume of T3 and T4 patients was markedly superior to that of T1 and T2 patients (P < 0.05), and T4 was markedly superior to T3 (P < 0.05).

Conclusion

In summary, different TNM stages and degrees of tumor invasion had certain effects on the prognosis of BC patients, and the prognosis of patients can be preliminarily predicted and evaluated by tumor TNM stages.

bladder cancer

lymph node metastasis

prognosis

urodynamic status

hydronephrosis

Bladder cancer (BC) is a common malignant tumor in the urinary system. It mainly occurs in people over 40 years old, with a peak incidence of 65 years old, and it is rare in people under 30 years old. In recent years, the incidence of BC has gradually increased, and it has become the 7th most common cancer type in men, but it is uncommon in women [1]. According to the statistical results, the incidence and mortality of BC in China in 2015 were approximately 80,500 cases (62,100 males and 18,400 females) and approximately 32900 cases (25,100 males and 7800 females), respectively. According to whether the tumor invades the muscularis of the bladder, it is classified into nonmuscularis invasive BC and muscularis invasive BC. The nature and severity of tumors may vary with the classification of tumors [2]. Noninvasive papillary carcinoma is a tumor that grows on a small portion of tissue, is easily resected, does not grow deeper, and is present only in the inner layer of cells (transitional epithelium). Nonmuscle invasive BC has the potential to spread to the bladder muscles or other parts of the body, and in addition, all types of BC cells can spread from the bladder to other parts of the body [3]. Common symptoms of BC include hematuria, remarkable weight loss, unilateral low back pain, and changes in urination habits (such as frequent urination, urgency, dysuria, and dysuria), among which painless gross hematuria is the first symptom; that is, blood in urine is not accompanied by frequent urination, urgency, and dysuria [4]. In the case of painless gross hematuria, BC is the first consideration; of course, it may also be kidney cancer or ureteral cancer, and further examination is needed. However, BC is the most common, which needs to be further diagnosed by ultrasound, CT, and cystoscopy [5]. Current studies have found that the occurrence and progression of BC is a multifactor and multistep pathological process, and its related mechanism has not been clarified. It is generally believed that smoking, excessive arsenic in drinking water, insufficient drinking water, chronic bladder irritation and infection, genetic factors, family history, and chemoradiotherapy are risk factors for BC [6]. Some risk factors that can’t be avoided through behavioral changes should be noted, and regular physical examinations should be performed after the age of 50. Chronic urinary tract inflammation increases the risk of BC, so inflammation should be treated as early as possible [7].

BC not only has a high incidence but also causes great pain and harm to patients. To treat BC, it is necessary to first define its stage [8]. BC is classified into early, middle, and late stages according to the time of onset. In the early stage, the symptoms of BC are not obvious, the invasion degree of cancer cells to tissues is relatively small, and the cure rate is relatively high. In the middle and late stages, the clinical symptoms of BC are obvious, the invasion scope of cancer cells is substantially expanded, and distant metastasis occurs, which is almost incurable [9, 10]. In BC TNM staging, T represents tumor status, N represents lymph node status, and M represents distant metastasis (reaching distant organs through blood circulation) [11]. The stage of T is distinguished according to the depth of cell invasion of the bladder. The superficial level is the first stage, the shallow base level is the second stage, deep base level invasion or even penetration is the third stage, and adjacent organs are the fourth stage. According to the depth of invasion, TNM stage can be used to judge prognosis. The five-year survival rate of stage 1 BC is high, while that of stage 4 BC is extremely low [12, 13]. To accurately determine the TNM stage of BC, the following methods should be used for diagnosis. The purpose of T staging is to identify the extent of local tumors and understand the metastasis of lymph nodes and other organs through imaging examination [14]. Imaging should be performed if BC is considered an invasive carcinoma. Currently, lymph node excision biopsy is the only method for N staging that can exclude lymph node metastasis (LNM). CT and MRI have a high rate of missed diagnosis of LNM [15, 16]. For M staging, the presence of distant metastases must be determined before treatment can be developed. All patients must undergo chest X-ray examination. If bone involvement is suspected, bone scanning should be performed. If suspicious lesions are found in bone scanning, MRI can be performed to determine bone metastases [17].

The stage of BC refers to the depth of tumor invasion and metastasis. Pathological stage and clinical stage are the most valuable parameters to judge the prognosis of bladder tumors [18]. At present, the TNM staging method is usually used in clinical practice, and bladder tumors are simply classified into nonmuscle-invasive BC and muscle-invasive BC, among which nonmuscle-invasive BC is the most common, accounting for more than 80% [19]. Therefore, the predictive value of TNM stage and tumor invasion degree on the prognostic risk of BC patients was discussed to assist doctors in adopting comprehensive treatment as early as possible, including chemotherapy and radiotherapy, to prevent tumor recurrence and metastasis and improve the survival rate of patients.

The Research Objects

In this study, 90 cases of BC patients hospitalized in the Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College from October 2017 to December 2019 were selected as the research objects. There were 56 males and 34 females aged 50–70 years.

Inclusion criteria: (1) all patients were diagnosed with BC by preoperative urinary B-ultrasound, CT, MRI, and cystoscopy and were treated by laparoscopic radical cystectomy; (2) all patients were diagnosed with BC by intraoperative pathology; (3) patients aged 50 ~ 70 years old; (4) patients with no pelvic surgery before participating in the study; and (5) patients with normal coagulation function and platelets.

Exclusion criteria: (1) patients with incomplete clinical data and medical history information; (2) patients who were mentally ill and unable to cooperate with the research; (3) patients with a history of radiotherapy, chemotherapy, and immune adjuvant therapy before participating in the study; (4) patients with severe heart and liver and kidney dysfunction; and (5) patients with autoimmune diseases.

Patient data

Age (> 65 years old, ≤ 65 years old), sex (male, female), smoking history (yes, no), drinking history (yes, no), combined chronic diseases (yes, no), hydronephrosis (yes, no), and other general conditions were collected. Tumor size (> 3 cm, ≤ 3 cm), LNM (with and without), TDD (low differentiation, high differentiation), and TNM stage (T1, T2, T3, T4) of patients were collected.

BC Patients’ TNM staging

The TNM staging (according to BC TNM staging 2017 AJCC Eighth edition) of the patients with imaging examination is shown in Table 1. Stage T1 (32 cases) showed tumor infiltration into the lamina propria (subepithelial connective tissue). In the T2 stage (22 cases), there was tumor invasion into the muscularis propria (T2a: tumor invasion into the superficial muscularis, i.e., intramuscular 1/2; T2b: tumor infiltrates deep muscularis, i.e., 1/2 muscularis externally). Stage T3 (24 cases) showed tumor infiltration into perivesical tissues (T3a: visible under a microscope; T3b: visible to the naked eye, the extrabladder mass.). Stage T4 (12 cases) showed tumor invasion of the prostate, uterus or vagina, pelvic cavity, or abdominal wall tissues (T4a: tumor invasion of the prostate/uterus/vagina; T4b: tumor invasion of the pelvic/abdominal wall).

Table 1

BC TNM staging system.
TNM staging			Tumor situation
T	T1	/	Tumor infiltrating lamina propria (subepithelial connective tissue)
	T2	/	Tumor infiltrating intrinsic muscle layer
	/	T2a	The tumor infiltrating the superficial muscle layer (medial 1/2 muscle layer)
	/	T2b	The tumor infiltrating deep muscle layer (lateral 1/2 muscle layer)
	T3	/	Tumor infiltrating the tissues around the bladder
	/	T3a	Microscope visible
	/	T3b	Visible to the naked eye (extrabladder mass)
	T4	/	Tumor infiltrating prostate, uterus or vagina, pelvic cavity, or abdominal wall.
	/	T4a	Tumor infiltrating prostate/uterus/vagina
	/	T4b	Tumor infiltrating pelvic/abdominal wall
N	N0	/	Area-free LNM
	N1	/	Single zone LNM
	N2	/	Multiple zones LNM
	N3	/	Common iliac artery LNM
M	M0	/	No distant metastasis
	M1	/	Distant metastasis
	/	M1a	LNM exceeding common iliac artery
	/	M1b	Nondistant LNM

Operation Methods

In this study, all patients were treated by laparoscopic radical cystectomy, and the patients were anesthetized by endotracheal general anesthesia in the supine position. The ureter was free, and bilateral pelvic lymph nodes were cleaned as follows. The retroperitoneum was opened where the ureter crosses the iliac vessels, and the ureter was free from the inside of the external iliac artery to the entrance of the bladder. Then, the left and right internal and external iliac lymph nodes and obturator lymph nodes were freed and removed in turn with noninvasive grasping forceps and an ultrasonic scalpel and then removed with lithotomy forceps [20]. The two sides and bottom walls of the bladder were dissociated, the bilateral vas deferens and seminal vesicles were dissociated, and the vas deferens was severed. The bottom of the bladder was separated into the space of Disse, and the rectum was pushed downward until the tip of the prostate. The bladder side ligament and prostatic ligament were dissociated, the urethra was disconnected, and the prostate was removed. The peritoneum was cut at the top of the bladder to the posterior pubic anterior prostatic space with a super knife, and the pelvic floor fascia was opened. After the tip of the prostate was dissociated, the dorsal penile vein complex was sutured with 2 − 0 barbed wire, the tip of the prostate and the urethra were severed, and the whole bladder was completely removed [21]. Through a subumbilical incision, each layer of the abdominal wall was cut longitudinally into the abdominal cavity, and the resected whole bladder was removed. A ureteral wall stoma was made as follows. The left ureter was passed through the back of the sigmoid colon, and F7 single J tubes were inserted into both ureters. The incision was fixed with 0/5 Wei Qiao thread, and the incision was sutured.

Observation Indexes

The intraoperative bleeding, operation time, and hospital stay of patients were observed and recorded, and the incidence of postoperative complications of patients with different stages were statistically analyzed, including postoperative infection, bleeding, and anastomotic leakage. Urodynamic status was measured and analyzed, including postoperative bladder volume, maximum urine flow rate, and residual urine volume.

Method of Statistics

SPSS 23.0 was employed for statistical data analysis in this study. The Shapiro‒Wilk test was adopted to test whether the data were normally distributed. A univariate multisample mean was utilized to compare the measurement data in accordance with the normal distribution between multiple groups, and an independent sample t test was adopted to compare the measurement data between two groups. The measurement data that did not conform to a normal distribution were tested by the rank sum test. Enumeration data were examined. The statistical results with P < 0.05 were considered statistically significant.

Basic Patient Information

Table 2 shows the basic information and statistical results of all patients. Among the 90 BC patients included, most patients were over 65 years old, accounting for 53.33%, while male and female patients accounted for 62.22% and 37.78%, respectively. The proportions of patients with smoking history, drinking history, chronic diseases, and hydronephrosis were 43.33%, 38.89%, 45.56%, and 35.56%, respectively.

Table 2

Basic information of patients.
Item	Category	Number of patients (n = 90)	Proportion (%)
Age	> 65 years old	48	53.33
Age	≤ 65 years old	42	46.67
Sex	Male	56	62.22
Sex	Female	34	37.78
Smoking history	Yes	39	43.33
Smoking history	No	51	56.67
Drinking history	Yes	35	38.89
Drinking history	No	55	61.11
Coexisting chronic diseases	Yes	41	45.56
Coexisting chronic diseases	No	49	54.44
Hydronephrosis	Yes	32	35.56
Hydronephrosis	No	58	64.44

Table 3 shows the tumor conditions of 90 patients, including tumor size, LNM, TDD, and TNM stage. Among them, TNM stage T1, T2, T3, and T4 patients accounted for 35.56%, 24.44%, 26.67%, and 13.33%, respectively.

Table 3

Tumor status.
Item	Category	Number of patients (n = 90)	Proportion (%)
Tumor size	> 3 cm	52	57.78
Tumor size	≤ 3 cm	38	42.22
LNM	Yes	35	38.89
LNM	No	55	61.11
TDD	Lowly	42	46.67
TDD	Highly	48	53.33
TNM stage	T1	32	35.56
	T2	22	24.44
	T3	24	26.67
	T4	12	13.33

Analysis of Prognostic Factors of BC Patients

In this study, age, sex, smoking history, drinking history, chronic diseases, hydronephrosis, tumor size, LNM, TDD, TNM stage and other factors that may affect the prognosis of BC patients were analyzed. The results are shown in Table 4. Figures 1 and 2 show the changes in the 1-, 2-, and 3-year survival rates of patients with different ages, sexes, tumor metastasis, and TNM stages. There were no remarkable differences in 1-, 2-, and 3-year survival rates among patients with different ages, sexes, smoking history, chronic diseases, and tumor sizes (P > 0.05). According to the results of univariate analysis, hydronephrosis, occurrence of LNM, TDD, and TNM stage of BC patients had a great influence on the prognosis of BC patients (P < 0.05). However, age, sex, smoking history, chronic diseases, and tumor size had no notable influence on the prognosis (P > 0.05).

Table 4

Univariate analysis of influencing prognosis.
Item	Category	Patient proportion	Survival rate (%)			P
Item	Category	Patient proportion	1-year	3-year	5-year	P
Age	> 65 years old	53.33	85.4	78.3	58.6	> 0.05
Age	≤ 65 years old	46.67	87.3	80.1	61.2	> 0.05
Sex	Male	62.22	79.8	64.3	51.2	> 0.05
Sex	Female	37.78	78.3	62.3	53.8	> 0.05
Smoking history	Yes	43.33	76.8	65.9	41.5	> 0.05
Smoking history	No	56.67	80.3	71.8	50.2	> 0.05
Drinking history	Yes	38.89	76.4	65.2	48.4	> 0.05
Drinking history	No	61.11	81.8	74.7	52.3	> 0.05
Coexisting chronic diseases	Yes	45.56	78.1	62.3	41.2	> 0.05
Coexisting chronic diseases	No	54.44	83.4	72.5	50.8	> 0.05
Hydronephrosis	Yes	35.56	60.1	45.3	12.4	< 0.05
Hydronephrosis	No	64.44	85.7	69.7	59.8	< 0.05
Tumor size	> 3 cm	57.78	80.2	61.7	45.3	> 0.05
Tumor size	≤ 3 cm	42.22	79.4	62.4	52.3	> 0.05
LNM	Yes	38.89	45.8	36.5	11.4	< 0.001
LNM	No	61.11	80.2	74.3	60.2	< 0.001
TDD	Lowly	46.67	80.2	43.6	30.1	< 0.05
TDD	Highly	53.33	85.4	77.2	54.8	< 0.05
TNM stage	T1	35.56	85.2	76.8	64.5	< 0.001
	T2	24.44	83.4	76.5	61.2
	T3	26.67	71.2	45.8	31.2
	T4	13.33	50.3	20.1	10.3

Multiple Regression Analysis of Influencing Factors of BC Patients’ Prognosis

According to the above single-factor analysis results, hydronephrosis, LNM, TDD, and TNM stage of BC patients had a remarkable impact on the prognosis of BC patients (P < 0.05). Therefore, they were included in multiple regression analysis, and the results are shown in Table 5. According to the analysis results, the TDD, hydronephrosis, occurrence of LNM, and TNM stage had a great impact on the prognosis of BC patients; that is, the TDD, hydronephrosis, occurrence of LNM, and TNM stage were independent influencing factors on the prognosis of BC patients.

Table 5

Multiple regression analysis of factors influencing prognosis.
Item	B	SE	Wald	HR	95% CI	P
TDD	0.467	0.233	7.257	1.449	1.023–3.257	< 0.05
Hydronephrosis	0.532	0.274	5.987	1.478	1.012–2.046	< 0.05
TNM stage	0.668	0.208	5.642	2.014	1.124–4.325	< 0.01
LNM	0.702	0.231	6.331	1.876	1.018–4.872	< 0.05

Analysis of Surgical Situation of Patients with Different TNM Stages

According to the above results, TNM stage had a remarkable impact on the prognosis of BC patients (P < 0.01). Therefore, 90 BC patients included in this study were graded into T1 stage (n = 32), T2 stage (n = 22), T3 stage (n = 24), and T4 stage (n = 12) according to TNM stage, and the operation conditions of patients with different stages were compared. These included operative time (Fig. 3), intraoperative blood loss (Fig. 4), postoperative exhaust time (Fig. 5), and hospital stay (Fig. 6). According to Fig. 3, the operation times of T1, T2, T3, and T4 stage patients were 126.38 ± 9.41 min, 127.21 ± 10.28 min, 133.02 ± 9.72 min, and 132.18 ± 10.08 min, respectively. The operation time of T3 and T4 patients was substantially longer than that of T1 and T2 patients (P < 0.05).

According to Fig. 4, the intraoperative blood loss of patients in the T1, T2, T3, and T4 stages was 112.17 ± 11.38 mL, 120.34 ± 13.21 mL, 180.22 ± 11.27 mL, and 203.12 ± 12.49 mL, respectively. The amount of intraoperative blood loss in T3 and T4 patients was markedly superior to that in T1 and T2 patients (P < 0.05), and the intraoperative blood loss during T4 was greater than that during T3 (P < 0.05).

According to Fig. 5, the postoperative exhaustion times of patients in the T1, T2, T3, and T4 stages were 70.84 ± 9.87 h, 78.97 ± 10.02 h, 86.33 ± 9.54 h, and 92.54 ± 10.33 h, respectively. The postoperative exhaust time of T3 and T4 patients was substantially longer than that of T1 and T2 patients (P < 0.05), and the postoperative exhaust time of patients in T4 was longer than that in T3 (P < 0.05).

According to Fig. 6, the hospitalization times of patients in the T1, T2, T3, and T4 stages were 11.76 ± 3.88 d, 12.02 ± 3.96 d, 16.37 ± 4.33 d, and 18.54 ± 4.21 d, respectively. The length of hospital stay in T3 and T4 patients was substantially longer than that in T1 and T2 patients (P < 0.05), and the length of hospital stay during T4 was substantially longer than that during T3 (P < 0.05).

Postoperative Complications of Patients with Different TNM Stages

The incidence of postoperative complications in patients with stage T1, T2, T3, and T4 disease was analyzed, and the results are shown in Fig. 7. The main postoperative complications were incision bleeding, incision infection, pulmonary infection and anastomotic leakage, and the incidence of various complications was greatly higher in T4 patients, while the incidence of these complications was notably lower in T1 patients (P < 0.05).

Urodynamic Status of Patients with Different TNM Stages

Urodynamic measurements (including bladder volume, maximum urine flow rate, and residual urine volume) were analyzed in patients at stages T1, T2, T3, and T4. Figure 8 shows the comparison results of bladder volumes of patients. The bladder volumes of patients in the T1, T2, T3, and T4 stages were 380.21 ± 27.64 mL, 368.92 ± 25.32 mL, 292.33 ± 26.43 mL, and 286.54 ± 23.45 mL, respectively. The bladder volumes of T3 and T4 patients were notably inferior to those of T1 and T2 patients (P < 0.05).

Figure 9 shows the comparison results of the maximum urinary flow velocity of patients. The maximum urinary flow velocities of patients in the T1, T2, T3, and T4 phases were 15.12 ± 1.79 mL/s, 14.18 ± 1.65 mL/s, 12.03 ± 1.87 mL/s, and 11.76 ± 2.01 mL/s, respectively. The maximum urinary velocity of T3 and T4 patients was notably inferior to that of T1 and T2 patients (P < 0.05), and T2 stage was notably inferior to T1 stage (P < 0.05).

Figure 10 shows the comparison results of residual urine volume. The residual urine volumes of patients in the T1, T2, T3, and T4 stages were 27.23 ± 6.78 mL, 27.08 ± 6.54 mL, 42.37 ± 7.02 mL, and 47.54 ± 6.69 mL, respectively. The residual urine volume of T3 and T4 patients was markedly superior to that of T1 and T2 patients (P < 0.05), and T4 was markedly superior to T3 (P < 0.05).

BC, as the most common urological tumor, has a higher incidence in men and a lower incidence in women. The clinical staging of bladder tumors is the most valuable parameter to judge the prognosis of bladder tumors, as is the pathological grading. Currently, the TNM staging method, which is popular internationally, is widely used [22]. BC is classified into nonmuscular invasive BC, including carcinoma in situ Ta and T1 tumors, and muscular invasive BC over stage T2 [23, 24]. Nonmuscular invasive BC confined to the mucosa and submucosa is called superficial BC, accounting for 75%-85%, and muscular invasive BC accounts for 15%-25%. In contrast, approximately 70% of nonmuscle-invasive BCs were Ta stage lesions, 20% were T1 stage lesions, and 10% were bladder carcinoma in situ. Although carcinoma in situ also belongs to nonmuscle-invasive BC, it is poorly differentiated and belongs to a highly malignant tumor [25]. The probability of progression to muscular invasion is much higher, so it is necessary to distinguish carcinoma in situ from Ta and T1 BC. The research results of Chung et al. (2013) [26] showed that lymphatic metastasis is the most common method of bladder tumor metastasis, which can be transferred to the internal and external iliac obturator lymph nodes or to the common iliac lymph nodes, which are the first lymph nodes for metastasis [27]. Blood metastasis is common in the late stage and is most commonly seen in the liver, followed by organs such as the lungs and bones. When it spreads directly, it appears in the prostate and posterior urethra. Bladder tumors can metastasize at the bladder incision and skin incision during the operation. Pedrosa et al. (2014) [28] found that the prognosis of nonmuscular invasive BC was better. For stage Ta BC, the 10-year survival rate can reach more than 90%, and the 5-year survival rate of muscular invasive BC can reach more than 60% through effective treatment, which means that most patients can survive for a long time. However, for nonmuscular invasive BC, there is a 40%-60% chance of recurrence for middle-risk patients, so patients need regular postoperative reexamination [29, 30]. For muscular invasion, the possibility of recurrence is higher, so a strict follow-up plan should be made. For low-risk patients, reexamination should be performed every six months, and observation should be conducted for five years. For high-risk patients, reexamination every three months, every six months after two years, and every year for life after five years should be considered [31].

In this study, the 1-year, 2-year, and 3-year survival rates of patients with different ages, sexes, smoking history, drinking history, chronic diseases, hydronephrosis, tumor size, LNM, TDD, and TNM stage were compared. Univariate analysis showed that hydronephrosis, occurrence of LNM, TDD, and TNM stage had remarkable effects on the prognosis of BC patients (P < 0.05). However, age, sex, smoking history, chronic diseases, and tumor size had no substantial influence on the prognosis (P > 0.05). Therefore, TNM stage and LNM status of BC patients may all be influencing factors for prognosis. The results of multiple regression analysis showed that the TDD, hydronephrosis, occurrence of LNM, and TNM stage had a considerable influence on the prognosis of BC patients; that is, the TDD, hydronephrosis, occurrence of LNM, and TNM stage were all independent influencing factors on the prognosis of BC patients. Similar to the results of this study, Brieu et al. (2019) [32] showed that the prognosis of BC mainly depends on the TDD, invasion, and metastasis. If BC is confined to the bladder mucosa without metastasis, the prognosis is better after surgical treatment. If the patient’s tumor invasion is serious and metastasis has occurred, the prognosis will be poor [33]. In addition, the operation, complications, and urodynamics of patients with different TNM stages were analyzed, and it was found that there were remarkable differences in reoperation (operation time, intraoperative blood loss, hospitalization time, etc.), complications, and urodynamics (bladder capacity, maximum urine flow rate, residual urine volume, etc.) among patients with T1, T2, T3, and T4 stages (P < 0.05). Hence, there were differences in the prognosis and postoperative curative effect of BC patients with different TNM stages. According to the study of Boustead et al. (2014) [34], the treatment methods of BC are different with different stages. Most of them belong to nonmuscular invasive BC, which can be treated by transurethral surgery and perfusion with good prognosis. BC is a relatively common tumor. When patients develop diseases, they should be treated as soon as possible, and they should be reexamined regularly after surgery to prevent recurrence or metastasis of diseases [35]. In summary, TNM staging of bladder tumors and the degree of tumor invasion have a certain influence on the prognosis of patients; that is, TNM staging can preliminarily evaluate the prognosis of patients.

In this study, the survival rate of different types of BC patients and its influencing factors were analyzed. In addition, the postoperative curative effect and urodynamic status of patients were compared according to different TNM stages to study the predictive value of TNM stages and tumor invasion degree on the prognosis risk of BC patients. The results showed that different TNM stages and degrees of tumor invasion had a certain influence on the prognosis of BC patients, and the prognosis of BC patients could be preliminarily predicted and evaluated by tumor TNM stages.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the ethics committee of the Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College. All methods were performed in accordance with relevant guidelines and regulations. The patients and their families were aware of the content and methods of the study and agreed to sign the corresponding informed consent forms.

Consent for publication

All the authors have approved manuscript for publication.

Data Availability

The data supporting the findings of this study are available from the corresponding author.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Funding

The authors did not receive support from any organization for the submitted work.

Authors Contributions

XH,FY,XL and CH performed rat experiments and analysis, designed and drafted the study and wrote the main manuscript text. All authors reviewed the manuscript. All authors read and approved the final manuscript.

Acknowledgements

Not Applicable

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No competing interests reported.

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Prognostic Risk Prediction of Bladder Cancer Patients Regarding the Tumor-Node-Metastasis Staging System and Tumor Infiltration

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Patient data

BC Patients’ TNM staging

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Analysis of Prognostic Factors of BC Patients

Multiple Regression Analysis of Influencing Factors of BC Patients’ Prognosis

Analysis of Surgical Situation of Patients with Different TNM Stages

Postoperative Complications of Patients with Different TNM Stages

Urodynamic Status of Patients with Different TNM Stages

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