上尿路尿路上皮癌根治法手术预后相关因素分析

目的探讨影响上尿路尿路上皮癌患者预后的相关因素。方法回顾性分析2007年2月-2017年2月本院收治的107例上尿路尿路上皮癌患者的临床资料。男59例,女48例。年龄38~86岁,平均63.2岁。所有患者均行上尿路尿路上皮癌根治性手术,病理分期T1~4,病理分级为低/高级别。采用Kaplan-Meier生存分析法计算上尿路尿路上皮癌患者的总生存率(OS)及肿瘤特异性生存率(CSS)。采用Cox回归模型分析各临床特征与上尿路尿路上皮癌患者预后的相关性。结果本研究107例患者随访6~110个月,中位随访时间为32个月。其中38例行开放手术,69例行腹腔镜手术;肾盂癌53例,输尿管癌49例,肾盂癌合并输尿管癌5例。肿瘤位于左侧53例,右侧54例。肿瘤多发13例,单发94例。肿瘤分期:T1期29例,T2期37例,T3期35例,T4期6例。肿瘤低级别66例,高级别41例。淋巴结阳性40例。膀胱癌复发30例。29例患者死亡,其中8例死于其他原因。3年OS为81.2%,CSS为83.5%;5年OS为57.9%,CSS为62.8%。中位OS为32个月,中位CSS为31个月。单因素分析结果显示,患者的肿瘤分期、肿瘤多发、肿瘤部位、淋巴结阳性及膀胱癌复发与OS和CSS有相关性(P<0.05)。多因素分析结果显示,肿瘤分期(HR=2.090,95%CI 1.078~4.052,P=0.029;HR=2.854,95%CI 1.078~4.052,P=0.01)和肿瘤多发(HR=4.116,95%CI 1.710~9.910,P=0.002;HR=7.016,95%CI 1.710~9.910,P<0.001)是OS和CSS的独立预后因素。结论肿瘤分期、肿瘤多发、肿瘤部位、淋巴结阳性及膀胱癌复发与患者预后有相关性,而肿瘤分期和肿瘤多发是预后的独立影响因素。

Analysis of prognostic factors for upper urinary tract urothelial carcinoma

Objective To investigate the prognostic factors for upper urinary tract urothelial carcinoma (UTUC). Methods A total of 107 patients with UTUC, who were treated at the hospital from February 2007 to February 2017, were analyzed retrospectively. Totally 59 male and 48 female patients were enrolled. Their ages were from 38 to 86 years, and the mean age was 63.2 years. All the patients underwent radical surgery. The pathological stages included T1/T2/T3/T4, and the grades included low/high grade. The Kaplan-Meier method was adopted to determine overall survival (OS) and cancer-specific survival (CSS). The Cox proportional hazards regression model was used to study the relationship between the clinical factors and the prognosis of UTUC patients. Results In the study, the median follow-up time was 32 (range from 6-110) months for 107 patients. Among them, 38 patients underwent open surgery and 69 patients underwent laparoscopic surgery. There were 53 patients with pelvis cancer and 49 patients with ureter cancer, and 5 patients with both. There were 53 patients with tumor located in the left and 54 patients in the right. There were 94 patients with single tumor and 13 patients with multiple tumor.There were 29 patients in T1, 37 patients in T2, 35 patients in T3, and 6 patients in T4. There were 66 patients in low pathologic grade and 41 cases in high grade. There were 40 patients in positive lymph nodes and 30 patients in intravesical recurrence. Totally 29 patients were died, and among them, 8 patients were died for other causes. The 3-year OS and CSS were 81.2% and 83.5% respectively; the 5-year OS and CSS were 57.9% and 62.8% respectively; the median OS and CSS were 32 (21-46) months and 31 (20-45) months respectively. There was a strong correlation between OS and CSS and pathologic stage, multifocality, tumor location, positive lymph node and intravesical recurrence (P<0.05) by the univariate analysis, while the multiple Cox regression analysis showed that the pathologic stage (P=0.01) and multifocality (P<0.001) had a strong correlation with the prognosis of UTUC. Conclusion The prognosis of UTUC is correlated with the pathologic stage, multifocality, tumor location, positive lymph nodes, and intravesical recurrence. The pathological stage and multifocality were the independent risk factors of the prognosis for UTUC.