糖尿病对上尿路尿路上皮癌根治术后发生膀胱内肿瘤的风险分析

目的:探讨合并糖尿病（diabetes mellitus ，DM）的上尿路尿路上皮癌（upper urinary tract urothelial carcinoma ，UUT-UC）患者行根治性肾输尿管切除术（radical nephroureterectomy ，RNU ）及膀胱袖口状切除术后是否增加膀胱内肿瘤发生的风险。方法:回顾性分析天津医科大学第二医院2005年1 月至2013年12月282 例行根治性肾输尿管切除术及膀胱袖口状切除术，且既往无膀胱肿瘤病史的UUT-UC 患者临床病理资料，比较非DM组（233 例）与DM组（49例）无复发生存期（recurrence-free survival ，RFS）及肿瘤特异性生存期（cancer-specific survival ，CSS），并分析年龄、DM、病理分级及分期等因素对患者术后膀胱内肿瘤发生的影响。结果:纳入研究的患者术后中位随访时间为41个月，282 例中80例（28.4%）发生膀胱内肿瘤，中位发生时间为11个月。非DM患者RFS 较DM患者显著延长（P = 0.013）。 Cox 回归模型多因素分析显示，DM（P = 0.014）、肾孟癌合并输尿管癌（P = 0.001）与术后化疗（P = 0.024）是术后膀胱内肿瘤发生独立影响因素。结论:DM增加UUT-UC 患者术后膀胱内肿瘤发生风险，因此需要加强对合并DM患者术后的密切随访及血糖控制。 

Analysis of diabetes mellitus increasing the risk of intravesical recurrence in patients with upper urinary tract urothelial carcinoma after radical nephroureterectomy

Objective:To investigate whether the risk of intravesical recurrence increases in patients with upper urinary tract urothelial carcinoma (UUT-UC) and diabetes mellitus (DM) after radical nephroureterectomy (RNU) with bladder cuff excision. Methods:We ret-rospectively analyzed the clinicopathological data of 282 UUT-UC patients with no history of bladder neoplasm and who underwent RNU with bladder cuff excision in the Second Hospital of Tianjin Medical University from January 2005 to December 2013. The recurrence-free survival (RFS) and cancer-specific survival (CSS) were compared between the non-diabetic (233 patients) and diabetic (49 patients) patients. The factors influencing intravesical recurrence in patients with UUT-UC after RNU were analyzed. These factors included age, DM, pathologic grade, and stage. Results:Among the 282 patients included in the study, 80 (28.4%) patients developed intravesical recurrence during the median fol ow up of 41 months, and the median time to recurrence was 11 months. Non-diabetic patients had a significantly longer duration of bladder neoplasm RFS than diabetic patients (P=0.013). Multivariate analysis using Cox's regression model indicated that DM (P=0.014), renal pelvis and ureter tumor (P=0.001), and postoperative chemotherapy (P=0.024) were independent influential factors for intravesical recurrence in patients with UUT-UC after RNU with bladder cuff excision. Conclusion:DM posed an increased risk for intravesical recurrence after RNU with bladder cuff excision in patients with UUT-UC. Therefore, these patients need to be closely monitored, and their blood glucose must be controlled.