北京大学学报(医学版) ›› 2016, Vol. 48 ›› Issue (6): 1032-1037. doi: 10.3969/j.issn.1671-167X.2016.06.019

• 论著 • 上一篇    下一篇

上尿路尿路上皮癌术前预后相关因素分析及初步风险分层模型构建

邢云超,熊耕砚,方东,张争,蔡林,张雷,何志嵩,李学松△,周利群△   

  1. (北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京100034)
  • 出版日期:2016-12-18 发布日期:2016-12-18
  • 通讯作者: 李学松,周利群 E-mail: pineneedle@sina.com, zhoulqmail@sina.com
  • 基金资助:

    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)和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

Preoperative prognostic factors and preoperative risk stratification of upper tract urothelial carcinoma

XING Yun-chao, XIONG Geng-yan, FANG Dong, ZHANG Zheng, CAI Lin, ZHANG Lei, HE Zhi-song, LI Xue-song△, ZHOU Li-qun△   

  1. (Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China)
  • Online:2016-12-18 Published:2016-12-18
  • Contact: LI Xue-song, ZHOU Li-qun E-mail: pineneedle@sina.com, zhoulqmail@sina.com
  • Supported by:

    Supported by the National Natural Science Foundation of China (81372746), the Beijing Natural Science Foundation (7152416), the Capital Foundation for Clinical Characteristics and Application Research (Z151100004015173), and the Medical Cooperative Research Project Fund of Peking University Health Science Center and Taiwan University (BMU20120318)

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, eGFR)≥30 mL/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133 μmol/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133 μmol/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。

关键词: 尿道上皮, 癌, 移行细胞, 肿瘤复发, 局部, 预后, 危险因素

Abstract:

Objective: To identify the preoperative prognostic factors of upper tract urothelial carcinoma (UTUC) and construct preoperative risk stratification system. Methods: A retrospective study including 686 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 that 203 (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 (eGFR) ≥30 mL/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: Of the 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.

Key words: Urothelium, Carcinoma, transitional cell, Neoplasm recurrence, local, Prognosis, Risk factors

中图分类号: 

  • R737.1
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