局部晚期肾盂输尿管癌单纯手术与术后辅助放疗疗效比较

目的 比较肾盂输尿管癌单纯手术与术后辅助放疗的疗效。方法 回顾分析2005—2008年间 103例肾盂输尿管移行细胞癌患者的临床资料,37例行术后辅助三维适形放疗,66例单纯手术。局部控制率、生存率用Kaplan-Meier法计算并Logrank法检验及单因素分析,多因素分析采用Cox回归模型。结果 单纯手术组、术后放疗组随访率分别为89%、92%,其中随访满 5年者分别为33、17例。单纯手术组1、3、5年局部控制率分别为89%、74%、72%,术后放疗组分别为94%、90%、90%(χ²=3.90,P=0.048)。单纯手术组1、3、5年无膀胱癌发生率分别为87%、60%、57%,术后放疗组分别为94%、79%、79%(χ²=4.50,P=0.037)。单纯手术组1、3、5年总生存率为90%、71%、65%,术后放疗组分别为84%、65%、62%(χ²=0.32,P=0.573)。单因素和多因素分析均显示分期、淋巴结转移、手术断端阳性与总生存率相关(χ²=7.91、64.69、40.20和5.08、17.23、8.22,P=0.005、0.000、0.000和0.024、0.000、0.004)。结论 术后辅助三维适形放疗能提高肿瘤控制率,降低膀胱癌发生率,但在改善患者生存方面尚未现优势。

Efficacy of postoperative three-dimensional conformal radiotherapy in transitional cell carcinoma of the renal pelvis or ureter

Objective To evaluate the role of postoperative three-dimensional conformal radiotherapy (3DCRT) in transitional cell carcinoma of the renal pelvis or ureter. Methods We retrospectively reviewed a series of 103 patients with transitional cell carcinoma of the renal pelvis or ureter. All patients received surgery without distant metastases and had T₃ or T₄ disease, or grade 3 disease if T₂. No patient received chemotherapy. Thirty-seven patients received three-dimensional conformal radiotherapy (3DCRT) following surgery. Sixty-six patients received surgery alone. The local control rates and survival rates were calculated by Kaplan-Meier method and compared by Logrank test in univariate analysis. Cox regression was used for multivariate analysis. Results The follow-up rates were 89% and 92% in surgery alone and 3DCRT groups. The number of patients who had minimal followed-up time of 5 years were 33,37 in surgery alone and 3DCRT groups. The 1-,3-, and 5-year local control rates were 89% vs. 94%, 74% vs. 90%, and 72% vs. 90% in surgery alone and 3DCRT groups, respectively (χ²=3.90,P=0.048). The 1-,3-, and 5-year bladder tumor-free survival rates were 87% vs. 94%, 60% vs. 79%, and 57% vs. 79% in surgery alone and 3DCRT groups, respectively (χ²=4.50,P=0.037). The 1-,3-, and 5-year overall survival rates were 90% vs. 84%, 71% vs. 65%, and 65% vs. 62% in surgery alone and 3DCRT groups, respectively (χ²=0.32,P=0.573). Univariate and multivariate analyses showed that T stage, lymph node metastasis, positive surgical margin were correlated with overall survival rate (χ²=7.91,64.69,40.20 and 5.08,17.23,8.22,P=0.005,0.000,0.000 and 0.024,0.000,0.004). Conclusions 3DCRT may improve local control and reduce tumor recurrence in bladder in patients with locally advanced transitional cell carcinoma of the renal pelvis or ureter. However, 3DCRT does not improve overall survival in this group of patients.