摘要
目的:分析上尿路尿路上皮癌(upper tract urothelial carcinoma,UTUC)患者的术前预后因子,并构建适合中国患者的术前风险评估模型。方法:收集北京大学第一医院2003年至2013年的686例UTUC患者的临床和随访资料进行回顾性分析。结果:686例患者中,男性303例(44.2%),女性383例(55.8%),术后高分期(T3和T4)肿瘤203例(29.6%),高分级(G3)肿瘤300例(43.7%),淋巴结转移(N1)54例(7.9%),其中,肾盂肿瘤、肿瘤长径大于5 cm、肾小球滤过率(estimated glomerular filtration rate,e GFR)≥30 m L/min和男性与术后肿瘤高分期相关;输尿管肿瘤、肿瘤长径大于5 cm、没有吸烟史与术后肿瘤高分级相关;肾盂肿瘤、肿瘤长径大于5 cm和术前贫血与术后淋巴结转移相关。患者的平均随访时间65个月,其间有208例(30.3%)患者死于肿瘤,210例(30.6%)患者出现了膀胱复发,其中肿瘤长径大于5 cm(P=0.001)、伴随同侧肾积水(P=0.041)和术前贫血(P=0.001)是患者术后肿瘤特异性死亡的独立危险因子,输尿管肿瘤(P=0.04)、多发肿瘤(P=0.005)和术前血肌酐含量大于133μmol/L(P=0.036)是患者术后膀胱复发的独立危险因素。结论:在UTUC患者常见的术前临床参数中,肿瘤长径大于5 cm、伴随同侧肾积水和术前贫血与术后肿瘤特异性生存呈独立相关,输尿管肿瘤、多发肿瘤和术前血肌酐大于133μmol/L与术后膀胱复发呈独立相关。基于这些术前预后因素构建的中国患者术前风险分层系统,可以帮助临床医生在术前就对患者进行初步的风险评估,并指导后续的临床治疗。
Objective:To identify the preoperative prognostic factors of upper tract urothelial carcinoma(UTUC)and construct preoperative risk stratification system.Methods:A retrospective study including686 patients who were diagnosed with UTUC and received radical nephroureterectomy or partial ureterectomy in Peking University First Hospital during 2003 and 2013.Results:Of the 686 UTUC patients,303(44.2%)were male and 383(55.8%)female.The postoperative pathological examination showed that203(29.6%)had high tumor stages(T3,T4),300(43.7%)had high tumor grades(G3)and 54(7.9%)had lymph nodes metastasis(N1).After multivariate analysis,renal pelvic tumor,large tumor,estimated glomerular filtration rate(e GFR)≥30 m L/min,and male were associated with high tumor stage.Ureteral tumor,large tumor,and non-smoking history were associated with high tumor grade.Renal pelvis tumor,large tumor,and preoperative anemia were associated with positive N status.During the follow-up,208(30.3%)died for cancer and 210(30.6%)developed intravesical recurrence.Multivariate analysis showed:large tumor(P=0.001),concomitant ipsilateral hydronephrosis(P=0.041),and preoperative anemia(P=0.001)were independently associated cancer-specific mortality after surgery,while ureteral tumor(P=0.04),multiple tumor(P=0.005),and high preoperative creatinine(P=0.036)were independent risk factors for intravesical recurrence.Conclusion:Ofthe preoperative clinical parameters of UTUC patients,the large tumor,concomitant ipsilateral hydronephrosis,and preoperative anemia were independently associated with cancer-specific mortality after surgery.Ureteral tumor,multiple tumor,and high preoperative creatinine were independently associated with intravesical recurrence after surgery.
作者
邢云超
熊耕砚
方东
张争
蔡林
张雷
何志嵩
李学松
周利群
XING Yun-chao;XIONG Geng-yan;FANG Dong;ZHANG Zheng;CAI Lin;ZHANG Lei;HE Zhi-song;LI Xue-song;ZHOU Li-qun(Department of Urology,Peking University First Hospital,Institute of Urology,Peking Universit,National Urological Cancer Center,Beijing 100034,China)
出处
《北京大学学报(医学版)》
CAS
CSCD
北大核心
2016年第6期1032-1037,共6页
Journal of Peking University:Health Sciences
基金
国家自然科学基金(81372746)
北京市自然科学基金(7152416)
首都临床特色应用研究与临床推广基金(Z151100004015173)
北京大学医学部与台湾大学医学合作研究项目基金(BMU20120318)资助
关键词
尿道上皮
癌
移行细胞
肿瘤复发
局部
预后
危险因素
Urothelium
Carcinoma
transitional cell
Neoplasm recurrence
local
Prognosis
Risk factors
