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...     

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。     

非肌层浸润性膀胱癌行初次经尿道膀胱肿瘤电切术的术后复发危险因素分析

背景与目的：非肌层浸润性膀胱癌（non-muscle invasive bladder cancer,NMIBC）患者行经尿道膀胱肿瘤电切术（transurethral resection of bladder cancer,TURBT）的术后复发率较高，分析NMIBC患者行初次TURBT术后复发危险因素的相关研究较少。本研究旨在分析NMIBC患者行初次TURBT的术后复发危险因素，有助于筛选复发高危人群，预防性采取相应的干预措施。方法：选取2015年12月—2020年5月在电子科技大学附属肿瘤医院行初次TURBT治疗的NMIBC患者197例，随访24～77个月，根据是否复发分为复发组（48例）和非复发组（149例）。对两组临床资料进行单因素分析，将单因素分析差异有统计学意义的指标纳入多因素logistic回归分析，筛选TURBT术后复发的可能危险因素。结果：单因素分析显示，未复发组初治时有肉眼血尿、二次电切、肿瘤T分期为T1期、肿瘤分级为高级别、肿瘤多发及未行即刻膀胱内灌注化疗的占比低于复发组，差异有统计学意义（P<0.05）。两组的性别、年龄、肿瘤家族史、吸烟史、肿瘤大小及后...     

膀胱移行细胞癌术后上尿路再发肿瘤(附7例报告)

膀胱移行细胞癌术后再发上尿路肿瘤临床上很少见 ,文献报道其发生率仅 1～ 2 %左右。现对我们 1978～ 1993年间因膀胱移行细胞癌手术后发生上尿路肿瘤的资料进行回顾性分析 ,探讨再发的有关因素和处理方法 ,以期有益于临床工作。临床资料自 1978年～ 1993年间我院收治了 2 83例无痛性肉眼血尿患者 ,血尿时间 1～ 2 6个月 (平均 7个月 ) ,年龄 2 2～ 78岁 (平均 52岁 ) ,经膀胱镜、Ｂ超及ＣＴ检查确诊为膀胱肿瘤 ,并且排除同时合并上尿路肿瘤。视肿瘤所在位置 ,浸润程度 ,单、多发性及全身状况选择膀胱癌黏膜下切除 ,膀胱部分切除或膀胱根治…     

肝癌术后早期复发临床危险因素的分析

目的:探讨肝癌术后早期复发的各项危险因素.方法:回顾性分析111例肝癌切除术后患者的资料,探讨各项临床病理因素与肝癌术后早期复发(≤1年)的关系.结果:111例肝癌根治性切除病例中,早期复发41例(36.9%).单因素分析表明,肿癌大小、有无子灶、脉管癌栓及术后区域化疗对术后早期复发有影响.多因素分析表明,有无子灶、脉管癌栓和术后区域化疗是影响术后早期复发的独立因素.早期复发组经外科治疗后1、2年生存率为65.9%和14.6%,明显高于姑息性治疗者,P<0.01.结论:有无子灶、脉管癌栓和术后区域化疗是影响肝癌术后早期复发的重要因素,早期复发积极外科处理能有效提高生存率.     

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。     

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。     

膀胱癌的非职业性危险因素

 膀胱癌是我国泌尿与男性生殖系统最常见的恶性肿瘤, 临床上以移行细胞癌多见。流行病学研究表明:发达国家男性膀胱癌的20% ～25% 和女性膀胱癌的6% ～11% 可归因于职业性接触某些芳香胺,提示除职业之外尚有其它重要的危险因素[1,2] 。因此,近年来膀胱癌非职业性危险因素的研究日益受到人们的重视。本文就有关的危险因素研究进展综述如下。     

浅表性膀胱癌根治术后发生尿道癌的危险因素分析

目的:探讨影响浅表性膀胱癌根治术后尿道癌发生的危险因素。方法:回顾分析2010年1月到2015年2月于我院行膀胱癌根治性切除术的60例浅表性膀胱癌患者临床资料,根据术后有无发生尿道癌分为尿道癌组10例,无尿道癌组50例,比较两组患者相关临床资料间的差异,并采用Cox回归模型进行分析得出影响浅表性膀胱癌根治性切除术后患者尿道癌发生的独立危险因素。结果:本组共发生10例（16.67％）尿道癌,病理类型均为尿路上皮癌,其中6例非原位新膀胱术中有4例双侧输尿管皮肤造瘘术,2例回肠膀胱术;23例肿瘤病灶≥2处;17例组织学分级为高分化尿路上皮癌。尿道癌组的无术前灌注化疗人数比例及侵及前列腺人数比例均高于非尿道癌组（P<0.05）。肿瘤侵及前列腺部尿道（HR=1.958,95％CI:1.151～3.331）、非原位新膀胱术（HR=2.123,95％CI:1.200～3.756）是浅表性膀胱癌根治性切除术后患者尿道癌发生的独立危险因素（P<0.05）,术前灌注化疗（HR=0.645,95％CI:0.336～0.863）是浅表性膀胱癌根治性切除术后患者尿道癌发生的保护因素（P<0.05）。结论:肿瘤侵及前列腺部尿道、非原位新膀胱术是浅表性膀胱癌根治性切除术后患者尿道癌发生的独立危险因素,术前灌注化疗是其保护因素,我们应当注重这些因素对有危险因素的患者行尿道切除及术前常规灌注化疗对于降低浅表性膀胱癌根治性切除术后患者尿道癌的发生有重要意义。     

Concomitant Bladder Tumor Is a Risk Factor for Bladder Recurrence but Not Upper Tract

Objective: To evaluate the clinical outcomes of UTUC patients with or without concurrent bladder tumor. Design, Setting, and Participants: The Clinical Research Office of the Endourology Society-Urothelial Carcinomas of the Upper Tract (CROES-UTUC) Registry included 1134 UTUC patients with or without concurrent bladder tumor treated between 2014 and 2019. Results: In 218 (19.2%) cases, concurrent bladder tumor was present, while in 916 (80.8%) patients, no bladder cancer was found. In the multivariable Cox regression analysis, concomitant bladder tumor (hazard ratio (HR) 1.562, 95% confidence interval (CI) 0.954–2.560, p = 0.076) indicated a trend associated with recurrence-free survival for UTUC. Further data dissection confirmed that concomitant bladder tumor is a risk factor of bladder recurrence (HR 1.874, 95% CI 1.104–3.183, p = 0.020) but not UTUC recurrence (HR 0.876, 95% CI 0.292–2.625, p = 0.812). Kidney-sparing surgery (KSS) (HR 3.940, 95% CI 1.352–11.486, p = 0.012), pathological T staging ≥ pT2 (HR 2.840, 95% 1.039–7.763, p = 0.042) were significantly associated with UTUC recurrence. KSS does not affect bladder recurrence (HR 0.619, 95% CI 0.242–1.580, p = 0.315). A limitation is the retrospective nature of the present study analysis. Conclusions: The presence of concomitant bladder tumor does not increase risk of UTUC recurrence, but it results in an increased risk of bladder recurrence. KSS does not affect bladder recurrence and can still be considered in patients with concomitant bladder tumor.     

不同麻醉方式及其他因素对膀胱癌切除术患者术后复发的影响

目的探讨不同麻醉方式及其他因素对膀胱癌切除术患者术后复发的影响。方法选择膀胱癌切除术的患者79例作为研究对象,记录所有患者的病历资料与麻醉相关资料,随访患者复发情况并进行影响因素的调查分析。结果79例患者的麻醉持续时间(82.42±14.29)min;椎管内麻醉45例,静吸复合麻醉34例。随访1年,复发13例,复发率为16.5%。单因素分析结果显示临床分期、病理特征、吸烟、饮酒、麻醉持续时间、麻醉方式与术后复发显著相关(P<0.05)。多因素Logistic回归分析结果显示临床分期(OR=8.815)、病理特征(OR=9.892)、吸烟(OR=4.912)、饮酒(OR=7.898),麻醉持续时间(OR=3.291)、麻醉方式(OR=1.333)都为导致术后复发的主要独立危险因素(P<0.05)。结论膀胱癌切除术患者术后复发比较常见,临床分期、病理特征、吸烟、饮酒、麻醉持续时间、麻醉方式都为导致术后复发的主要独立危险因素。     

Preoperative Pyuria Predicts for Intravesical Recurrence in Patients With Urothelial Carcinoma of the Upper Urinary Tract After Radical Nephroureterectomy Without a History of Bladder Cancer

BackgroundWe assessed preoperative pyuria as a significant predictor of intravesical recurrence (IVR) in patients with upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).Patients and MethodsWe evaluated the data from 268 patients with UTUC without a history of bladder cancer who had undergone RNU from 2006 to 2016 at 4 academic institutions. The associations between the clinical variables and the presence of pyuria were evaluated by univariate analysis. IVR was assessed using the Kaplan-Meier method and Cox regression analysis.ResultsThe median postoperative follow-up of patients with IVR-free survival was 29.1 months (interquartile range, 15.4-55.3 months). The rate of IVR was significantly greater in the patients with than in those without pyuria (P = .025). Multivariate analysis showed that preoperative pyuria (hazard ratio [HR], 1.70; P = .007), a ureteral tumor site (HR, 1.64; P = .012), and positive surgical margins (HR, 2.70; P = .013) were associated with a significantly increased risk of IVR. A postoperative risk stratification model using these factors showed significant differences among the 3 subgroups of patients with low, intermediate, and high risk. The 5-year IVR-free survival rates for the patients with low, intermediate, and high risk were 69.1%, 51.8%, and 18.8%, respectively (P = .004).ConclusionPreoperative pyuria, a ureteral tumor site, and positive surgical margins were associated with a significantly increased risk of IVR. Although external validation is required, the presence of preoperative pyuria could be a significant predictor of IVR in patients with UTUC after RNU.     

Preoperative Monocyte-to-lymphocyte Ratio Predicts for Intravesical Recurrence in Patients With Urothelial Carcinoma of the Upper Urinary Tract After Radical Nephroureterectomy Without a History of Bladder Cancer

BackgroundThis study aimed to investigate the preoperative monocyte-to-lymphocyte ratio (MLR) as a biomarker for intravesical recurrence (IVR) in upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU) for the first time.Patients and MethodsThis study involved the clinical data of 255 patients with UTUC without a history of bladder cancer who had undergone RNU from March 2004 to February 2019 at an academic institution. The associations between MLR and IVR were assessed with Kaplan-Meier method and Cox regression analysis.ResultsThe median follow-up was 43.93 months. Of the 255 patients, 37 developed IVR during the follow-up period. Kaplan-Meier analysis revealed that patients with high MLR (> 0.22) had poor IVR-free survival (P = .001); this prognostic value was in accordance with patients with high grade and more advanced stage UTUC. Cox regression preoperative models showed that ureteral tumor site (hazard ratio [HR], 2.784; P = .005), surgical approach (HR, 2.745; P = .008), and high MLR (HR, 4.085; P < .001) were an independent risk factor for IVR. These factors were used as a signature to establish a prognostic risk model, which revealed significant differences among the 3 subgroups of patients with low, intermediate, and high risk (P < .001).ConclusionUreteral tumor site, surgical approach, and preoperative MLR are significant predictors for IVR in patients with UTUC after RNU. MLR may become a useful biomarker to predict IVR in patients with UTUC after RNU.     

Tumor Markers for Diagnosis,Monitoring of Recurrence and Prognosis in Patients with Upper Gastrointestinal Tract Cancer

To evaluate the value of combined detection of serum CEA, CA19-9, CA24-2, AFP, CA72-4, SCC, TPA andTPS for the clinical diagnosis of upper gastrointestinal tract (GIT) cancer and to analyze the efficacy of thesetumor markers (TMs) in evaluating curative effects and prognosis. A total of 573 patients with upper GIT cancerbetween January 2004 and December 2007 were enrolled in this study. Serum levels of CEA, CA19-9, CA24-2,AFP, CA72-4, SCC, TPA and TPS were examined preoperatively and every 3 months postoperatively by ELISA.The sensitivity of CEA, CA19-9, CA24-2, AFP, CA72-4, SCC, TPA and TPS were 26.8%, 36.2%, 42.9%, 2.84%,25.4%, 34.6%, 34.2% and 30.9%, respectively. The combined detection of CEA+CA199+CA242+CA724 hadhigher sensitivity and specificity in gastric cancer (GC) and cardiac cancer, while CEA+CA199+CA242+SCCwas the best combination of diagnosis for esophageal cancer (EC). Elevation of preoperative CEA, CA19-9 andCA24-2, SCC and CA72-4 was significantly associated with pathological types (p<0.05) and TNM staging (p<0.05).Correlation analysis showed that CA24-2 was significantly correlated with CA19-9 (r=0.810, p<0.001). The levelsof CEA, CA19-9, CA24-2, CA72-4 and SCC decreased obviously 3 months after operations. When metastasisand recurrence occurred, the levels of TMs significantly increased. On multivariate analysis, high preoperativeCA72-4, CA24-2 and SCC served as prognostic factors for cardiac carcinoma, GC and EC, respectively. combineddetection of CEA+CA199+CA242+SCC proved to be the most economic and practical strategy in diagnosis of EC;CEA+CA199+CA242+CA724 proved to be a better evaluation indicator for cardiac cancer and GC. CEA andCA19-9, CA24-2, CA72-4 and SCC, examined postoperatively during follow-up, were useful to find early tumorrecurrence and metastasis, and evaluate prognosis. AFP, TPA and TPS have no significant value in diagnosis ofpatients with upper GIT cancer.     

上尿路同时性和异时性上皮肿瘤的组织学和临床特征

目的：分析上尿路上皮肿瘤的组织学和临床特征及预后因素。方法：对60例同时性和异时性上尿路上皮肿瘤，进行回顾性总结及统计学分析。结果：单发肿瘤50例，多发10例，表浅型肿瘤18例（30．0％），浸润型42例（70．0％）。复发23例（38．3％），频率为0．76（0．15－1．71）次／年，平均间隔16．5个月。局部淋巴结转移3例，远处转移4例，其原发肿瘤均为浸润型。浸润型肿瘤或远处转移者预后较差，复发者中远期生存率较低。结论：尿路上皮肿瘤具有多发性和复发性的特点，应加强早期发现、早期诊断方面的研究。建议首次膀胱镜检查应在初诊后的第4个月，第二次间隔8个月，以后每年一次，持续10年。每两次膀胱镜检查之间，行超声波检查。     

Retrospective Evaluation of Risk Factors and Immunohistochemical Findings for Pre-Neoplastic and Neoplastic lesions of Upper Urinary Tract in Patients with Chronic Nephrolithiasis

Background: Urinary stones are known predisposing factors for upper urinary tract carcinoma (UUTC) which are commonly detected at advanced stage with poor outcome because of rarity and lack of specific criteria for early detection. Aims and objectives: The main aim was to evaluate the impact of age, gender andstone characteristics on risk of developing UUTC in patients with chronic nephrolithiasis. We also discuss the role of aberrant angiogenesis (AA) and immunohistochemical expression of p53, p16INK4a, CK20 and Ki-67 in diagnosis of pelvicalyceal neoplastic (NL) and pre-neoplastic lesions (PNL) in these patients. Materials and Methods: Retrospective analysis of pelvicalyceal urothelial lesions from 88 nephrectomy specimens were carried out in a tertiary care centre from June 2012 to December 2014. Immunohistochemistry (IHC) was performed on 37 selected cases. Computed image analysis was performed to analyse aberrant angiogenesis. Results: All UUTC (5.7%) and metaplastic lesions were found to be associated with stones. Some 60% were pure squamous cell carcinoma and 40% were transitional cell carcinoma. Odd ratios for developing NL and PNL lesions in presence of renal stone, impacted stones, multiple and large stag horn stones were 9.39 (95% CI 1.15-76.39, p value 0.05), 6.28 (95% CI 1.59-24.85, p value 0.000) and 7.4 (95% CI, 2.29-23.94, p value 0.001) respectively. When patient age was ≥ 55, the odds ratio for developing NL was 3.43 (95% CI 1.19-9.88, p value 0.019). IHC analysis showed that mean Ki-67 indices were 3.15 ± 3.63 % for non-neoplastic lesions, 10.0±9.45 % for PNL and 28.0± 18.4% for NL. Sensitivity and specificity of CK20, p53, p16INK4a, AA were 76% and 95.9%; 100% and 27.5%; 100% and 26.5%; 92.3 % and 78.8% respectively. Conclusions: Age ≥55 years, large stag horn stones, multiple stones and impacted stones are found to be associated with increased risk of NL and PNL in UUT. For flat lesions, a panel of markers, Ki 67 index >10 and presence of aberrant angiogenesis were more useful than individual markers.     

非肌层浸润性膀胱癌患者经尿道膀胱肿瘤电切术后复发的影响因素

目的 分析非肌层浸润性膀胱癌(NMIBC)患者经尿道膀胱肿瘤电切术(TURBT)后复发的影响因素.方法 回顾性分析168例NMIBC患者临床资料,患者均进行TURBT治疗.术后随访2年,统计患者复发情况,根据结果分为复发组与未复发组,分析NMIBC患者术后复发的影响因素.结果 随访2年,168例NMIBC患者有34例出...