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。

Recurrent urothelial cancer after resection of ureteral carcinoma

OBJECTIVE: To prevent and treat recurrent urothelial cancer after resection of ureteral carcinoma, recurrence-associated factors and their features were analyzed. METHODS: Thirty five cases of ureteral cancer were studied retrospectively. RESULTS: There were 16 cases of recurrent bladder cancer among 32 cases after kidney-ureter and partial bladder removal. Bladder cancer recurred in 10 of 14 cases (71.4%) with multiorgan urothelial cancers. Six out of 18 cases with single ureteral cancer had recurrent cancer in the bladder. In 5 of the 6 cases, the primary tumor was located at the lower ureter. None of the 4 cases in grade I had tumor recurrence while there were 16 cases of recurrent bladder cancer in 28 cases in grade II-III. There was one recurrent bladder cancer in 6 cases in stage T1 within 2 years after operation. Among 26 cases in stage T2-T3, 10 cases of recurrent bladder cancer occurred in 2 years. After 2 years, 5 recurrent cases were in stage T1-T2. There were 2 recurrent urothelial carcinomas in 3 cases whose tumors were removed by local resection. The time of recurrence was 3 months to 6.5 years (average 1.86 years). Of 16 cases with recurrent urothelial cancer, 3 were alive for more than 3 years after operation. Of 8 cases without recurrence 6 survived for more than 3 years. CONCLUSION: Recurrent urothelial cancer after resection of ureteral cancer occurs more frequently when the neoplasm is located in the lower ureter, involving more than one organ, with high-grade cell differentiation and high invasiveness. Prognosis of recurrent urothelial cancer is poor. Regular cystoscopic check-up is helpful to find the recurrence.