术前合并肾积水对膀胱癌根治术后患者生存预后的影响

  目的  探讨术前合并肾积水对病理TNM不同分期膀胱癌根治术后患者生存的影响。  方法  回顾性分析2013年1月至2017年12月231例于昆明医科大学第二附属医院行膀胱癌根治性切除术患者的病例资料，根据术前有无合并肾积水分为合并肾积水组（96例）和未合并肾积水组（135例），比较两组的总生存（overall survival，OS ）率。采用Cox比例风险回归模型进行预后因素的单因素及多因素分析；根据不同TNM分期将患者进行分组，Kaplan-Meier法分别绘制生存曲线，采用Log-rank检验进行显著性分析。  结果  合并肾积水组与未合并肾积水组患者的3年和5年OS率分别为62.5%±4.9%和38.5%±5%与 74.8%±3.7%和66.8%±4.1%，未合并肾积水组均明显高于合并肾积水组（P<0.001）。多因素Cox比例风险回归模型分析显示，术前合并肾积水、病理T分期、淋巴结转移为术后OS的独立影响因素（P<0.05）。TNM分期的分层分析发现，合并肾积水的T2N0M0组与未合并肾积水的T3～4N0M0组（P=0.816），以及合并肾积水的T3～4N0M0组与未合并肾积水的TxN+Mx组之间的生存差异均无统计学意义（P=0.591）。  结论  术前合并肾积水是膀胱癌根治术后患者OS的独立影响因素，同时术前合并肾积水可使T2N0M0及T3～4N0M0患者的术后生存曲线向更晚的病理TNM分期偏移。 

Effect of preoperative hydronephrosis on survival and prognosis of patients with bladder cancer after radical cystectomy

  Objective  To observe the effect of preoperative hydronephrosis on the prognosis and survival of patients with different tumor–node–metastasis (TNM) stages of bladder cancer after radical cystectomy.   Methods  The clinical data of 231 patients undergoing radical cystectomy at The Second Affiliated Hospital of Kunming Medical University between January 2013 and December 2017 were retrospectively analyzed. According to the preoperative presence of hydronephrosis, the patients were assigned into groups with hydronephrosis (n=96) and without hydronephrosis (n=135), and the overall survival (OS) of the two groups was compared. Univariate and multivariate analyses of prognostic factors were performed using Cox proportional risk regression. Additionally, the patients were assigned into groups according to different TNM stages. Survival curves were drawn using the Kaplan-Meier method, and significance analysis was performed using the Log-rank test.   Results  The 3-year and 5-year OS of patients with hydronephrosis were 62.5%±4.9% and 38.5%±5%, respectively, and the 3-year and 5-year OS of patients without hydronephrosis were 74.8%±3.7% and 66.8%±4.1%, respectively-these were significantly higher than those of patients with hydronephrosis (P<0.001). Multivariate Cox proportional risk regression analysis showed that preoperative hydronephrosis, T stage, and lymph node metastasis were independent factors influencing postoperative OS. According to the stratified analysis on the different TNM stages, there was no significant difference in survival between the T2N0M0 group with hydronephrosis and T3–4N0M0 group without hydronephrosis (P=0.816), and between the T3–4N0M0 group with hydronephrosis and TxN+Mx group without hydronephrosis (P=0.591).  Conclusions  Preoperative hydronephrosis was an independent factor influencing OS after radical cystectomy. Subsequently, preoperative hydronephrosis can shift the postoperative survival curve of patients with cancer stages T2N0M0 and T3–4N0M0 to a later pathological stage.