肾移植受者上尿路尿路上皮癌术后膀胱复发的预后因素

doi:10.3969/j.issn.1671-167X.2015.04.011

摘要/Abstract

摘要：

目的：评价肾输尿管全长切除术治疗肾移植受者原发上尿路尿路上皮癌（upper tract urothelial carcinoma，UTUC）术后膀胱复发的独立危险因素。方法：回顾2006年4月至2013年3月临床诊断为肾移植后局限性UTUC并且排除既往或同期合并膀胱肿瘤的病例共38例，均接受后腹腔镜下肾输尿管全长切除术。采用Kaplan-Meier方法对临床病理特征、危险因素和术后膀胱无复发生存率进行单因素分析。采用单因素和多因素Cox比例风险回归模型分析影响膀胱肿瘤复发的独立危险因素。结果：本组患者随访时间12~104个月，中位随访时间38个月，其间膀胱复发率42.1%（16/38），其中75.0%复发于术后2年内，手术与复发间隔时间6~48个月，中位复发时间15.5个月。单因素分析显示，原肾为马兜铃酸肾病（aristolochic acid nephropathy，AAN）、肿瘤为多中心和累及输尿管下段可增加膀胱复发风险。术后2年膀胱复发率，原肾AAN组为62.5%（5/8），肿瘤多中心发病组为46.2%（12/26）。多因素分析结果表明，肿瘤多中心发病（HR=2.603，95% CI=1.529~8.906，P=0.019）和原肾马兜铃酸肾病（HR=2.179，95% CI=1.085~8.093，P=0.038）是术后膀胱复发的独立预后危险因素。结论：肾移植受者UTUC经腹腔镜肾输尿管全长切除术后膀胱复发率高，大多数病例于术后2年内复发，多因素分析显示，肿瘤多中心发病和原肾AAN是术后膀胱复发的独立预后危险因素。

关键词: 泌尿道, 癌, 移行细胞, 膀胱肿瘤, 肿瘤复发, 局部, 肾移植

Abstract:

Objective：To elucidate clinicopathological independent prognostic factors for intravesical recurrence after nephroureterectomy for native upper tract urothelial carcinoma (UTUC) in renal transplant recipients. Methods: In this study, 38 patients clinically diagnosed as localized UTUC after renal transplantation were included, and treated by retroperitoneal laparoscopic nephroureterectomy between April 2006 and March 2013, after exclusion of those with a previous and/or concurrent history of bladder cancer. The clinicopathologic features, risk factors, and intravesical recurrence free survival were analyzed using the Kaplan-Meier method. Univariate and multivariate analyses by Cox’s proportional hazards regression model were used to identify independent risk factors for intravesical tumor recurrence. Results: Of all the patients, 16/38 (42.1%) developed subsequent intravesical recurrence during a median follow-up period of 38 months (range 12 to 104 months), of whom, 12/16 (75.0%) developed recurrent bladder cancer within 2 years after nephroureterectomy, and the median interval between surgery and intravesical recurrence was 15.5 months (range 6 to 48 months). Multifocal tumors, native aristolochic acid nephropathy (AAN) and distal ureter involvement were determined as risk factors for intravesical recurrence by univariate analysis. The intravesical recurrence rate was 62.5%(5/8) in the group of native AAN , and 46.2% (12/26) in the group of multifocality. By multivariate analyses, multifocality (HR=2.603, 95% CI=1.529-8.906, P=0.019) and native AAN (HR=2.179, 95% CI=1.085-8.093, P=0.038) were identified as independent predictors for the development of recurrent bladder cancer after surgery for UTUC in renal transplant recipients. Conclusion: The incidence of intravesical recurrence after laparoscopic nephroureterectomy for UTUC in renal transplant recipients is high, and most subsequent bladder cancers recur within 2 years after surgery. Tumor multifocality and native AAN are significant independent risk factors in developing initial intravesical recurrence after laparoscopic surgery for primary UTUC after renal transplantation.

Key words: Urinary tract, Carcinoma, transitional cell, Urinary bladder neoplasms, Neoplasm recurrence, local, Kidney transplantation

中图分类号:

R737.14

刘余庆, 卢剑, 赵磊, 侯小飞, 马潞林. 肾移植受者上尿路尿路上皮癌术后膀胱复发的预后因素[J]. 北京大学学报(医学版), 2015, 47(4): 605-610.

LIU Yu-Qing, LU Jian, ZHAO Lei, HOU Xiao-Fei, MA Lu-Lin. Prognostic factors for intravesical recurrence after surgery for upper tract urothelial carcinoma in renal transplant recipients[J]. Journal of Peking University(Health Sciences), 2015, 47(4): 605-610.

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