47例输尿管移行细胞癌术后辅助放疗疗效与预后分析

目的 探讨输尿管移行细胞癌术后辅助放疗疗效及影响预后的因素.方法 回顾分析1998-2008年内接受术后辅助放疗的47例输尿管移行细胞癌患者的临床资料.其中T_3+T_4期患者31例,7例有淋巴结转移.39例病理分级为c3,断端阳性13例.中位放疗剂量为印Gy(36～64 Gy),38例患者为区域照射.结果 中位随访时间21个月(6～88个月),随访率为92%.中位生存时间为35个月(5～88个月),2、5年总生存率分别为57%、49%.中位生存时间的单因素分析表明T_1+T_2期患者优于T_3+T_4期患者(42:19个月;χ~2=7.28,P=0.007),年龄≤65岁患者优于>65岁患者(28:18个月;χ~2=8.23,P=0.004),与根治术比较,非根治术患者在长期生存方面无显著性差别(21:20个月;χ~2=0.90,P=0.344);多因素分析表明T分期较晚(χ~2=7.89,P=0.005)、年龄>65岁(χ~2=4.85,P=0.028)、肾盂受累(χ~2=5.65,p=0.018)和肿瘤位于中下段(χ~2=6.08,P=0.014)是预后不良因素.结论 术后辅助放疗能改善局部晚期输尿管移行细胞癌手术切除患者疗效,T分期较晚及年龄>65岁是预后不良因素.

Treatment results and prognostic analysis of 47 patients with urethral transitional cell carcinoma treated with post-operative adjuvant radiotherapy

Objective To evaluate treatment results and prognostic factors of 47 patients withprimary urethral transitional cell carcinoma treated with post-operative adjuvant radiotherapy. Methods From October 1998 to October 2008, 47 patients with primary urethral transitional cell carcinoma received postoperative adjuvant radiotherapy. Thirty-one patients had stage T_3/T_4 disease, 7 had lymph node metastasis. Thirty-nine patients had G3 tumor, 13 had stump-positive. The median radiotherapy dose was 60 Gy (36-64 Gy). 81% patients (38/47) were treated with regional irradiation. Results The median follow-up time was 21 months (6 -88 months). The follow-up rate was 92%. The median overall survival time was 35 months (5 -88 months). The 2-and 5-year overall survival rates were 57% and 49%, respectively. In univariate analysis, the median overall survival time was better in patients with stage T_1 or T_2 compared with stage T_3 or T_4 tumor (42 months vs. 19 months,Χ~2 =7. 28,P=0. 007), with age of ≤65 years compared with >65 years (28 mouths vs 18 months,Χ~2 =8.23 ,P =0. 004). There was no significantdifference in the long term survival in patients with non-radical surgery compared with radical mastectomy (21 months vs. 20 months, Χ~2 = 0. 90, P = 0. 344). In multivariate analysis, the stage T_3 or T_4 (Χ~2 = 7. 89, P =0. 005), >65 years old (Χ~2 = 4.85, P = 0. 028), renal pelvis involvement (Χ~2= 5.65, P = 0. 018), and tumor located in the mid or inferior segment (Χ~2=6. 08 ,P =0. 014) were factors associated with poorer prognosis. Conclusions Postoperative adjuvant radiotherapy can improve the efficacy of patients with locally advanced urethral transitional cell carcinoma. Advanced T stage and > 65 years age are associated with poorer prognosis.