上尿路尿路上皮癌根治术后发生膀胱癌的危险因素研究

目的 探讨上尿路尿路上皮癌(UTUC)根治术后膀胱癌发生的危险因素。方法 选择UTUC患者112例,患者均行根治性肾输尿管切除术(RUN)联合膀胱袖口状切除术,依据UTUC术后是否发生膀胱癌分为膀胱癌组(30例)及无膀胱癌组(82例)。分析UTUC患者术后发生膀胱癌危险因素。结果 膀胱癌组Ⅲ～Ⅳ期、肿瘤位置位于输尿管、G3分级、术前存在膀胱癌病史及术前输尿管镜检查史比率均高于无膀胱癌组,差异有统计学意义(P<0.05);Logistic回归分析显示,肿瘤分期、病灶位置、分级,术前膀胱癌病史、输尿管镜检查史是影响UTUC根治术后膀胱癌发生的独立危险因素(P<0.05)。结论 肿瘤分期、病灶位置、分级,术前膀胱癌病史、输尿管镜检查史是影响UTUC根治术后膀胱癌发生的独立危险因素,术后需定期复查,以降低膀胱癌发生率。     

不同预防性膀胱内化疗方案对上尿路尿路上皮癌肾输尿管切除术后膀胱癌复发的影响

目的:比较不同预防性膀胱灌注化疗方案对UTUC患者的OS、CSS、IVRFS的影响。方法:回顾性分析2010年至2020年在我院泌尿外科接受RNU手术的387例UTUC患者的临床病例资料。术后随访10年,观察生存情况,同时对于患者的临床病理相关性数据进行统计学分析,选择Log-rank检验和Kaplan-Meier法,单因素多因素生存分析选择Cox回归分析。结果:所有患者的中位年龄为67岁［四分位数范围(IQR):33~90岁］,所有患者的中位随访时间为44个月［四分位数范围(IQR):3~140月］。三组患者的基线资料方面没有显著差异。Kaplan-Meier曲线显示,灌注组与未灌注组间,未灌注组、单次灌注组、多次灌注组三组间的总体生存率(OS)均有显著差异(P<0.000 1),三组间的肿瘤特异性存活率(CSS)有显著差异(P<0.000 1),同样三组间的膀胱内无复发生存率(IVRFS)也有显著差异(P=0.005)。未灌注组、单次灌注组与多次灌注组三组患者的1年,3年和5年的OS分别为85.3%、70.2%和61% vs 96.1%、84.1%和73.5% vs 96.8%、88.5%和84.3%。三组患者的1年,3年和5年的CSS分别为86.6%、73.6%和66.6% vs 97.4%、85.2%和74.4% vs 97.8%、89.4%和87%。三组患者的1年,3年和5年的IVRFS分别为95.2%、86.7%和74.1% vs 98.5%、89.4%和81.1% vs 98.9%、94.7%和88%。结论:术后膀胱内化疗可以明显降低UTUC患者的膀胱内复发率,尤其是侵袭性或高度恶性的UTUC。此外,我们认为多次膀胱灌注的疗效可能优于单次灌注。     

上尿路尿路上皮癌患者术后发生膀胱癌的危险因素分析

目的 探讨上尿路尿路上皮癌(UTUC)患者术后发生膀胱癌的危险因素,为临床预防措施的制定提供参考.方法 回顾性分析89例UTUC患者的临床资料,依据术后是否发生膀胱癌分为膀胱癌组和无膀胱癌组,统计2组年龄、性别、体质量指数、手术类型、肿瘤位置等一系列临床资料,先进行单因素分析,之后将具有统计学差异的变量纳入多因素Log...     

腹腔镜根治性单侧肾、输尿管及全膀胱切除治疗上尿路上皮癌合并膀胱癌的疗效观察

目的：探讨腹腔镜根治性单侧肾、输尿管及全膀胱切除术治疗上尿路上皮癌合并膀胱癌的安全性及可行 性。方法：回顾性分析我院 ２０１６年 ５月至 ２０２１年 ２月收治的 ９例单侧上尿路上皮癌合并膀胱癌的临床资料,术前 结合病史及膀胱镜活检结果、输尿管活检结果、泌尿系增强 ＣＴ、腹部增强 ＭＲＩ等检查提示单侧上尿路上皮癌合并膀 胱浸润性尿路上皮癌,手术方式采用腹腔镜根治性单侧肾、输尿管及全膀胱切除术。统计并分析患者手术及术后相 关指标、近期及远期并发症、生活质量评分及复发与转移情况。结果：９例手术均于腹腔镜下顺利完成,女性患者同 期切除子宫及附件,９例患者均采用健侧输尿管皮肤造口术。中位手术时间 ４２５（２６０～６１０）ｍｉｎ;中位术中出血量 １２００（３００～２５００）ｍＬ;围术期输血 ８例,中位输血量 １０００（０～２１００）ｍＬ;术后中位住院时间 １３（１０～２７）ｄ;中位随 访时间 ２５（６～６３）月。术后 ４例出现并发症,１例盆腔淋巴漏,１例造瘘口感染、尿路感染、输尿管吻合口狭窄,２例肾 功能不全。术后病理：肾盂癌、输尿管癌及浸润性膀胱癌 ２例,输尿管癌及浸润性膀胱癌 ６例,肾盂癌及膀胱浸润性 癌 １例。９例患者生活质量评分术后 ６月较术前均提高。术后 ３例行化疗,１例吉西他滨 ＋顺铂方案化疗 １周期,１ 例吉西他滨 ＋顺铂方案化疗 ２周期,此 ２例化疗后均因骨髓抑制及自身原因不愿再继续化疗;１例吉西他滨 ＋卡铂 方案化疗 ４周期;另外 ６例不愿接受化疗。９例均定期复查随访。１例患者术后 ９月出现肾功能不全进展至尿毒症 期,未行透析等治疗,于术后 １０月死亡;１例患者术后 ３８月出现复发转移,于术后 ３８月死亡,其余患者随访生存良 好。结论：上尿路上皮癌合并浸润性膀胱癌临床少见且治疗棘手,手术治疗创伤大,同期腹腔镜单侧肾、输尿管切除 ＋膀胱全切术是一种安全有效的治疗术式,该术式具有创伤小、恢复快等微创优势,提高术后生活质量,肿瘤治疗效 果好,可以获得较长的生存期。     

输尿管癌术后再发尿路上皮癌

目的为防治输尿管癌术后再发尿路上皮癌,对其再发因素及特点进行探讨。方法采用回顾性研究对３５例输尿管癌进行随访总结。结果肾输尿管膀胱部分切除的３２例中,再发膀胱癌１６例,占５０．０％。同时发生尿路上皮多器官癌１４例,再发膀胱癌１０例,占７１．４％;输尿管单处癌１８例,再发膀胱癌６例,占３３．３％,其中５例为输尿管下段癌术后再发。细胞分级：Ｇ１级４例,无一例再发;Ｇ２～Ｇ３级２８例,再发膀胱癌１６例,占５７．１％。分期：Ｔ１期６例,２年内再发膀胱癌１例;Ｔ２～Ｔ３期２６例,２年内再发膀胱癌１０例,２年后再发５例均为Ⅰ～Ⅱ期。３例肿瘤局部切除术后再发上尿路癌２例。再发时间为术后３个月～６．５年（平均１．８６年）。１６例术后再发尿路上皮癌生存超过３年者３例,８例非再发尿路上皮癌生存超过３年者６例。结论输尿管下段癌同时发生尿路上皮多器官癌和肿瘤细胞分化不良、分期高的浸润性肿瘤术后膀胱癌再发率高,术后应定期做膀胱镜检查。再发尿路上皮癌生存率低,预后不良。     

上尿路尿路上皮癌患者根治术前行输尿管镜活检的临床研究

目的:探讨CT尿路造影(computed tomography urography,CTU)诊断明确的上尿路尿路上皮癌(upper tract urothelial carcinoma,UTUC)患者行根治性肾输尿管切除(radical nephroureterectomy,RNU)术前是否有必要行输尿管镜活检。方法:回顾性分析2011年9月至2020年5月郑州大学第一附属医院73例术后病理确诊为UTUC患者的病例资料,比较CTU与输尿管镜活检诊断UTUC的阳性率,并分析输尿管镜活检与根治术后肿瘤病理分级的不一致性。结果:73例患者中70例行CTU检查者均提示异常,确诊阳性率为88.6%(62/70),术后病理证实均为尿路上皮肿瘤。行CTU检查后又行输尿管镜活检患者为61例,确诊阳性率为91.8%(56/61)。输尿管镜活检为临床高级别、低级别肿瘤分别占39.3%(24/61)、52.5%(32/61),术后病理诊断为高级别和低级别肿瘤分别占77.1%(47/61)和22.9%(14/61)。输尿管镜活检为临床低级别的肿瘤中,56.2%(18/32)术后病理升级为高级别肿瘤。CTU检查...     

膀胱微乳头型尿路上皮癌1例报告

膀胱浸润性尿路上皮癌微乳头型(infiltrating urothelialcarcinoma,micropapilly variant)是1种新近提出的尿路上皮癌的独特亚型,它不仅具有独特的组织学结构,在临床上也具有自己的特点,有很高的转移率和复发率。对临床病理医师而言,加强对此亚型肿瘤的正确认识,并与其它类型膀     

开放手术与后腹腔镜手术治疗器官局限性上尿路上皮癌的疗效比较

目的:比较开放手术与后腹腔镜手术治疗器官局限性上尿路上皮癌的疗效。方法:回顾性分析我院2010年01月至2015年12月75例接受手术治疗器官局限性上尿路上皮癌患者的临床资料,其中34例行开放肾输尿管加膀胱部分切除术（ONU组）治疗,41例行后腹腔镜肾输尿管加膀胱部分切除术（LNU组）治疗,比较两组患者的基线临床资料、围术期资料及随访预后结果。结果:ONU组的手术时间短于LNU组［136.0（111.0~180.0） min vs 180.0（130.0~210.0）min,Z= 2.525,P=0.012］。LNU组的出血量少于ONU组［100（100~200） mL vs 200（100~300） mL,Z= 2.197,P=0.028］。两组患者术后排气时间、引流管去除时间、术后住院时间及术后并发症发生率差异无明显统计学意义（P＞0.05）。ONU组中位随访时间42.5个月,LNU组中位随访时间41.0个月,总生存率（P=0.817）、肿瘤特异性生存率（P=0.448）、无复发进展率（P=0.789）、膀胱内无复发率（P=0.138）在两组患者中差异无明显统计学意义。结论:开放手术与后腹腔镜镜手术均是治疗器官局限性尿路上皮癌的有效方法,应根据临床具体情况选择手术方式。     

高级别且淋巴结阴性上尿路尿路上皮癌患者的不同转移部位的预后因素分析

目的：探讨根治性肾输尿管切除术（radical nephroureterectomy,RNU）后高级别且淋巴结阴性上尿路尿路上皮癌（upper tract urothelial carcinoma,UTUC）患者的不同转移部位对预后的影响。方法：回顾性分析2010年2月至2020年12月355例哈尔滨医科大学附属肿瘤医院行RNU后病理证实为高级别且淋巴结阴性UTUC患者的临床资料,行预后相关因素的单因素及Cox比例风险回归模型多因素分析。结果：355例患者中77例（21.7%）出现转移,93例（26.1%）死亡,中位随访时间为45个月,中位年龄为67岁。肝脏、骨骼和多部位转移的中位生存时间（overall survival,OS）分别为6、6和5个月。Cox比例风险回归模型多因素分析显示,膀胱内复发（intravesical recurrence,IVR）、肿瘤大小≥2 cm、肿瘤病理分期>T2期是患者转移的独立预测因素。结论：UTUC患者出现肝脏转移、骨转移和多部位转移相对较快,预后较差,而出现肺转移和淋巴结转移的预后相对较好。发生转移的晚期UTUC患者行同步放化疗、化疗联合免...     

Prolonged pneumoperitoneum time is an independent risk factor for intravesical recurrence after laparoscopic radical nephroureterectomy in upper tract urothelial carcinoma

Objective

To evaluate the impact of pneumoperitoneum time on intravesical recurrence (IVR) in upper tract urothelial carcinoma (UTUC) patients who underwent laparoscopic radical nephroureterectomy (LRNU).

Association of perioperative blood transfusion with oncologic outcomes after radical nephroureterectomy for upper tract urothelial carcinoma

BackgroundTo test the hypothesis that perioperative blood transfusion (PBT)impacts oncologic outcomes of patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).MethodsRetrospective analysis of 2492 patients with UTUC treated at 23 institutions with RNU between 1987 and 2007.Cox regression models addressed the association of PBT with disease recurrence, cancer-specific mortality and any-cause mortality.ResultsA total of 510 patients (20.5%) patients received PBT. Within a median follow-up of 36 months (Interquartile range: 55 months), 663 (26.6%) patients experienced disease recurrence, 545 patients (21.9%) died of UTUC and 884 (35.5%) patients died from any cause. Patients who received PBT were at significantly higher risk of disease recurrence, cancer-specific mortality and overall mortality than patients not receiving PBT in univariable Cox regression analyses. In multivariable Cox regression analyses that adjusted for the effects of standard clinicopathologic features, PBT did not remain associated with disease recurrence (HR: 1.11; 95% CI 0.92–1.33, p = 0.25), cancer-specific mortality (HR: 1.09; 95% CI 0.89–1.33, p = 0.41) or overall mortality (HR: 1.09; 95% CI 0.93–1.28, p = 0.29).ConclusionsIn patients undergoing RNU for UTUC, PBT is associated with disease recurrence, cancer-specific survival or overall survival in univariable, but not in multivariable Cox regression analyses.     

External validation of an online nomogram in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma

Background:

The objective was to validate an online nomogram developed based on the French collaborative national database on upper urinary tract urothelial carcinoma (UUT-UC) using a different cohort.

Methods:

The study comprised 328 patients with UUT-UC who underwent radical nephroureterectomy. The discrimination of models was quantified using Harrell''s concordance index. The relationship between the model-derived and actuarial cancer-specific mortality was graphically explored within calibration plots. Calibration was also assessed using the quartiles of the predicted survival at 3 and 5 years and calculation of the corresponding observed Kaplan–Meier estimates. Clinical net benefit was evaluated constructing decision curve analysis.

Results:

The discrimination accuracy of the nomograms at 3 and 5 years was 71.6% and 71.8%, respectively. Although nomograms discriminated well by Kaplan–Meier curves, and log-rank tests were all highly significant, the calibration plots tended to exaggerate the overestimation of mortality between predicted and observed probabilities at 3 and 5 years for survival. When compared with the AJCC/UICC staging system, the nomograms performed well across a wide range of threshold probabilities using decision curve analysis.

Conclusion:

The online nomogram is a highly accurate prognostic tool for patients with UUT-UC treated with radical nephroureterectomy. The model can provide an accurate estimate of the individual risk of cancer-specific mortality. Further improvement and implementation of novel molecular marker is needed.     

Contralateral upper tract urothelial carcinoma after nephroureterectomy: the predictive role of DNA methylation

Background

Aberrant methylation of genes is one of the most common epigenetic modifications involved in the development of urothelial carcinoma. However, it is unknown the predictive role of methylation to contralateral new upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). We retrospectively investigated the predictive role of DNA methylation and other clinicopathological factors in the contralateral upper tract urothelial carcinoma (UTUC) recurrence after radical nephroureterectomy (RNU) in a large single-center cohort of patients.

Methods

In a retrospective design, methylation of 10 genes was analyzed on tumor specimens belonging to 664 consecutive patients treated by RNU for primary UTUC. Median follow-up was 48 mo (range: 3–144 mo). Gene methylation was accessed by methylation-sensitive polymerase chain reaction, and we calculated the methylation index (MI), a reflection of the extent of methylation. The log-rank test and Cox regression were used to identify the predictor of contralateral UTUC recurrence.

Results

Thirty (4.5%) patients developed a subsequent contralateral UTUC after a median follow-up time of 27.5 (range: 2–139) months. Promoter methylation for at least one gene promoter locus was present in 88.9% of UTUC. Fewer methylation and lower MI (P = 0.001) were seen in the tumors with contralateral UTUC recurrence than the tumors without contralateral recurrence. High MI (P = 0.007) was significantly correlated with poor cancer-specific survival. Multivariate analysis indicated that unmethylated RASSF1A (P = 0.039), lack of bladder recurrence prior to contralateral UTUC (P = 0.009), history of renal transplantation (P < 0.001), and preoperative renal insufficiency (P = 0.002) are independent risk factors for contralateral UTUC recurrence after RNU.

Conclusions

Our data suggest a potential role of DNA methylation in predicting contralateral UTUC recurrence after RNU. Such information could help identify patients at high risk of new contralateral UTUC recurrence after RNU who need close surveillance during follow up.     

上尿路移行细胞癌术后预防性膀胱灌注的临床研究

目的:探讨上尿路移行细胞癌术后预防性膀胱灌注的有效性。方法:61例上尿路移行细胞癌患者行根治性切除术,其中34例患者术后预防性使用吡柔比星膀胱灌注,27例患者单纯随访,比较两组患者2年内膀胱肿瘤的发生率以及发生时间,并观察药物灌注毒副反应发生的情况。结果:吡柔比星灌注组膀胱癌发生率为14.7%,观察随访组膀胱癌的发生率为37.0%,差异有统计学意义(P<0.05),再发时间分别为20个月和14个月,二者比较差异有统计学意义(P<0.05)。患者灌注过程中均耐受,未出现中止灌注的情况。结论:本研究初步显示,吡柔比星预防性膀胱灌注可有效减少膀胱肿瘤的发生,毒副反应少,值得临床推广。     

Prognostic relevance of postoperative platelet count in upper tract urothelial carcinoma after radical nephroureterectomy

Aim of the studyTo assess the impact of perioperative platelet count (PLT) kinetics on recurrence-free survival (RFS) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).MethodsFrom three prospectively maintained databases of three tertiary care centres a total of 269 patients undergoing RNU without perioperative treatment between 1996 and 2011 were considered for this analysis. Pre- and postoperatively elevated PLT count was defined as >400 × 10⁹/L. PLT levels were measured 1–3 days preoperatively and 7–10 days postoperatively. The median follow-up was 24 months (Interquartile range (IQR): 10–52). A new weighted scoring model was developed to predict recurrence after RNU based on significant parameters of multivariable analysis.ResultsThe 5-year RFS in patients with preoperatively normal and elevated PLT count was 58.3% and 29.3%, respectively (p < 0.001). The 5-year-RFS was 57.6% in patients with normal postoperative PLT count and 29.7% in those with elevated PLT levels (p < 0.001). In multivariable analysis, pT-stage, lymphovascular invasion, ureteral margin status and postoperative thrombocytosis remained independent predictors for RFS. The 5-year RFS in patients with a score of 0 (low-risk), 1 (intermediate-risk) and 2–4 (high-risk) was 77.7%, 47.5% and 12.3%, respectively (p < 0.001). Consideration of the variable postoperative thrombocytosis in the final model increased its predictive accuracy by 1.9% with a concordance index of 0.758 (p = 0.015).ConclusionPLT kinetics is significantly associated with RFS after RNU for UTUC. We constructed a simple, PLT-based prognostic model for recurrence after RNU.     

Highly predictive survival nomogram after upper urinary tract urothelial carcinoma

BACKGROUND:

Nephroureterectomy is the surgical standard of care for patients with upper urinary‐tract urothelial carcinoma. The objectives of the current study were to identify the most informative predictors of cancer‐specific mortality after nephroureterectomy, to devise an algorithm capable of predicting the individual probability of cancer‐specific mortality, and to compare its prognostic accuracy to that of the International Union Against Cancer (UICC) staging system.

METHODS:

Within the Surveillance, Epidemiology, and End Results database, the authors identified 5918 patients who had been treated with nephroureterectomy. Within the development cohort (n = 2959), multivariate Cox regression models predicting cancer‐specific mortality were fitted by using age, stage, nodal status, sex, grade, race, type of surgery (nephroureterectomy with or without bladder‐cuff removal), and tumor location (renal pelvis vs ureter). Backward variable elimination according to the Akaike information criterion identified the most accurate and parsimonious model. Model validation and calibration were performed within the external validation cohort (n = 2959). External validation was also applied to the UICC staging system.

RESULTS:

The 5‐year freedom from cancer‐specific mortality rates in both the development and external validation cohorts was 77.3%. The most informative and parsimonious nomogram for cancer‐specific‐mortality–free survival relied on age, pT and pN stages, and tumor grade. In external validation, nomogram prediction of 5‐year cancer‐specific‐mortality–free rate was 75.4% accurate and was significantly better (P < .001) than the UICC staging system (64.8%).

CONCLUSIONS:

The current nomogram is capable of predicting the prognosis in patients with upper urinary‐tract urothelial carcinoma treated by nephroureterectomy with better accuracy than the UICC staging system. The authors recommend the application of this nomogram to routine clinical practice when counseling or making clinical decisions. Cancer 2010. © 2010 American Cancer Society.