肾积水程度和肿瘤直径作为输尿管移行细胞癌术前预测因素分析

目的:评估输尿管移行细胞癌中肾积水程度与肿瘤直径的术前预测价值。 方法:总结 312名行肾输尿管切除术的输尿管移行细胞癌患者的临床资料，分析其肾积水程度和肿瘤直径与T(TNM)分期的相关性及肾积水程度与肿瘤直径对预后的影响。结果:肾积水程度为0级的患者有33人，1～2级108人，3～4级171人。CT扫描横断面测量肿瘤直径＜1.5 cm的患者120人，≥1.5 cm且＜2.5 cm者111人，≥2.5 cm者81人。在肾积水3～4级的171名患者中，浸润性肿瘤患者147人（86.0%）。在肿瘤直径≥1.5 cm的192名患者中，浸润性肿瘤患者153人（79.7%）。肾积水程度与肿瘤直径与T分期具有相关性（P＜0.001）。肾积水程度和肿瘤直径影响输尿管癌的疾病特定生存率，具有显著意义（分别为P=0.009，P=0.001）。结论:输尿管癌患者肾积水程度和肿瘤直径与T分期具有相关性，并且影响预后。对有严重肾积水或肿瘤直径较大的患者应该积极手术治疗。

Hydronephrosis and tumor diameter as preoperative forecast factors in ureteral transitional cell carcinoma

Objective: To evaluate the clinical significance of the hydronephrosis level and the tumor diameter in ureteral transitional cell carcinoma. Methods: From 2005 to 2013, the medical records of 312 patients who were treated with nephroureterectomy and diagnosed with ureteral transitional cell carcinoma were retrospectively reviewed. The correlation between the two facotrs and the pathologic T (TNM)stage was investigated. The effects of the level of hydronephrosis and tumor diameter on the prognosis were evaluated. Results: The level of hydronephrosis was 0 in 33 patients, 1 to 2 in 108, and 3 to 4 in 171. The tumor diameter measured on the transverse section of the computed tomography scan was less than 1.5 cm in 120 patients, 1.5 cm or greater but less than 2.5 cm in 111 patients, and 2.5 cm or greater in 81 patients. Of the 171 patients with level 3 to 4 hydronephrosis, invasive tumor was found in 147(86.0%). Of the 192 patients with a tumor diameter of 1.5 cm or greater, invasive tumor was found in 153(79.7%). The level of hydronephrosis and the tumor diameter were correlated with the T stage (P＜0.001). Furthermore , the level of hydronephrosis (P=0.009) and the tumor diameter (P=0.001) had a significant influence on disease-specific survival. Conclusion: The results of the study have demonstrated that the level of hydronephrosis and the tumor diameter correlated with the pathologic T stage have a significant influence on prognosis. Therefore, radical surgery is required for patients with severe hydronephrosis or a large tumor, rather than conservative surgery.