原发性输尿管癌影响预后因素分析

Analysis of prognostic factors of primary ureteral carcinoma

目的 探讨原发性输尿管癌影响预后因素及术后发生膀胱癌的危险因素。 方法 16 0例输尿管癌中男 93例 ,女 6 7例 ,平均年龄 6 3.7岁。左侧 81例 ,右侧 79例 ;上段 30例 ,中段 2 1例 ,下段 96例 ,单侧多发 13例。病理分期Ta9例 ,T15 8例 ,T2 4 6例 ,T3 4 1例 ,T46例 ;分级G14例 ,G2 119例 ,G3 37例。 16 0例均行手术治疗 ,其中肾、输尿管全长加膀胱袖状切除 12 4例 (77.5 % )。总结临床病理学资料 ,对随访结果进行统计学分析。 结果 患者 5年生存率 5 3.0 % ,其中Ta、T1、T2 患者 5年生存率 (83.3%、71.9%、5 9.1% )与T3 和T45年生存率 (37.5 %、16 .7% )比较差异有统计学意义 (P <0 .0 0 0 1) ;G1、G2 患者的 5年生存率 (10 0 .0 %、6 3.5 % )与G3 (19.0 % )比较差异有统计学意义 (P =0 .0 0 1)。肿瘤分期分级是影响预后的因素。 16 0例输尿管癌术后发生膀胱癌者 38例 (2 3.8% )。多因素分析结果显示 ,伴有同发膀胱癌和下段输尿管癌是术后发生膀胱癌的危险因素 (P =0 .0 0 1,P =0 .0 0 5 )。 结论 原发性输尿管癌分期分级是影响预后因素 ;伴有同发膀胱癌和下段输尿管癌是术后发生膀胱癌的危险因素。

Objective To study the prognostic factors of primary ureteral carcinoma,and to analyze the risk factors of the occurrence of subsequent bladder cancer. Methods This series included 160 cases of primary ureteral carcinoma (93 men and 67 women;mean age,63.7 years).Of them,81 cases had the tumors on the left and 79 on the right;the tumors were located at the upper and middle parts of the ureter in 51 cases,and at the lower part in 96.Pathological staging showed T a (9 cases),T 1(58),T 2(46),T 3(41) and T 4(6);the grading showed G 1(4),G 2(119) and G 3(37).All the 160 cases underwent surgery.Among them,renal and full length of ureter resection plus sleeve resection of bladder were performed on 124 cases (77.5%).All the cases were followed up and the results were statistically analyzed. Results The overall 5-year survival rate was 53.0%.The 5-year survival rates of T a,T 1 and T 2 cases (83.3%,71.9%,59.1%,respectively) were significantly higher than those of T 3 and T 4 cases (37.5% and 16.7%,P<0.01);the 5-year survival rates of G 1 and G 2 cases (100% and 63.5%) were significantly higher than that of G 3 cases (19%,P=0.001).Of the 160 cases,38 (23.8%) developed bladder cancer subsequently.The tumor stage and grade were both the prognostic factors.Ureteral carcinoma with concurrent intravesical cancer and the lower segment carcinoma were both the risk factors for the occurrence of subsequent bladder cancer (P= 0.001,P=0.005,respectively). Conclusions The stage and grade of ureteral carcinoma are the prognostic factors.Ureteral carcinoma with concurrent bladder cancer and lower segment tumors in the ureter are the risk factors of subsequent bladder cancer.