Background and Objectives: Non-urothelial bladder tumors and secondary bladder involvement from extravesical primaries are uncommon but clinically challenging. We compared clinicopathologic patterns between primary non-urothelial tumors and secondaries, and explored correlates of adverse pathologic features to inform diagnostic triage and surgical planning. Methods: We performed a single-center retrospective cohort (2014–2024) of consecutive bladder lesions meeting WHO 2022 criteria and AJCC 8th staging. Eligible cases were primary non-urothelial malignancies (squamous cell carcinoma (SCC), adenocarcinoma (ADK), small-cell/neuroendocrine (NEC), sarcomatoid) or secondary bladder involvement (colorectal, prostate, cervix, ovary, uterus, breast). Outcomes included advanced pT (≥pT3), lympho–vascular invasion (LVI), perineural invasion (PNI), nodal metastasis, margin status, and composite adverse events. Results: Of 235 analyzable cases, 59 were primary and 176 were secondary. Age and sex distributions were similar. Secondaries had a higher adverse burden: advanced pT 56.8% vs. 23.7%, LVI 47.2% vs. 27.1%, PNI 40.3% vs. 22.0%, node-positive 11.9% vs. 0%, and any adverse 65.3% vs. 33.9% (all significant). Histology composition differed (p< 10−6): secondaries were ADK-dominant (59.1%), whereas primaries were enriched for SCC (38.5%), sarcomatoid (28.8%), and NEC (21.2%). Among secondaries, prostate origin showed the most ominous profile (advanced pT 97.5%, PNI 77.5%, positive margins 64.7%); colorectal cases combined high advanced pT (70.2%) with lower margin positivity (27.6%). Adverse-feature count correlated with pT (ρ = 0.586). Conclusions: Secondary bladder involvement carries substantially higher adverse-pathology rates than primary non-urothelial tumors, with origin-specific risk gradients (prostate > colorectal ≳ cervix). Rigorous origin adjudication and a margin-focused, anatomy-adapted surgical strategy may improve outcomes; prospective outcome-linked validation is warranted.
**背景与目的：** 非尿路上皮性膀胱肿瘤及膀胱外原发肿瘤继发性累及膀胱虽不常见，但临床处理颇具挑战。本研究旨在比较原发性非尿路上皮肿瘤与继发性累及肿瘤的临床病理学特征，并探讨不良病理特征的相关因素，以期为诊断分诊和手术规划提供依据。 **方法：** 我们进行了一项单中心回顾性队列研究（2014–2024年），纳入符合WHO 2022分类标准和AJCC第8版分期标准的连续膀胱病变病例。符合条件者包括原发性非尿路上皮恶性肿瘤（鳞状细胞癌、腺癌、小细胞/神经内分泌癌、肉瘤样癌）或继发性膀胱累及（原发灶来自结直肠、前列腺、宫颈、卵巢、子宫、乳腺）。观察指标包括高pT分期（≥pT3）、淋巴血管侵犯、神经周围侵犯、淋巴结转移、切缘状态以及复合不良事件。 **结果：** 在235例可分析病例中，59例为原发性，176例为继发性。年龄与性别分布相似。继发性病例的不良病理负担更高：高pT分期（56.8% vs. 23.7%）、淋巴血管侵犯（47.2% vs. 27.1%）、神经周围侵犯（40.3% vs. 22.0%）、淋巴结阳性（11.9% vs. 0%）以及至少一项不良特征（65.3% vs. 33.9%），差异均具有统计学意义。组织学构成亦显著不同（p < 10⁻⁶）：继发性病例以腺癌为主（59.1%），而原发性病例中鳞状细胞癌（38.5%）、肉瘤样癌（28.8%）和神经内分泌癌（21.2%）比例较高。在继发性病例中，前列腺来源者不良特征最为突出（高pT分期97.5%，神经周围侵犯77.5%，切缘阳性64.7%）；结直肠来源者则表现为高pT分期比例高（70.2%）但切缘阳性率较低（27.6%）。不良特征数量与pT分期呈正相关（ρ = 0.586）。 **结论：** 继发性膀胱累及肿瘤的不良病理率显著高于原发性非尿路上皮肿瘤，且风险梯度因原发部位而异（前列腺 > 结直肠 ≳ 宫颈）。严格的原发灶判定以及以切缘为重点、适应解剖结构的手术策略可能改善预后；有必要进行前瞻性、与临床结局关联的验证研究。
肿瘤(癌症)患者之家