上尿路移行细胞癌患者预后因素的Cox模型分析

Cox Model of Prognostic Factors in Patients With Transitional Cell Carcinoma of the Upper Urinary Tract

目的:通过Cox比例风险模型分析上尿路移行细胞癌患者的预后因素,指导临床治疗。方法:45例肾盂、输尿管移行细胞癌患者接受分析。年龄、性别、就诊时间、术前血色素、术中输血量、手术方式、病理分级、临床分期、肿瘤数目、肿瘤大小、术后有无复发、PCNA指数等12个变量进入Cox模型。结果:临床分期、PCNA指数、肿瘤数目、就诊时间四项参数与预后有关,其中临床分期、PCNA指数关系非常密切。病理分级、手术方式两项参数也有一定关系。根据临床分期和PCNA指数将患者分为A、B、C三组,术后5年生存率分别为92.65、38.4％与3％,差异非常显著。结论:Cox模型表明临床分期、PCNA指数与预后关系最密切。肿瘤数目、病理分级、就诊时间、手术方式对预后也有重要影响。根据临床分期和PCNA指数将患者分为不同的组,对判断预后,指导临床治疗有一定意义。

Objective: To determine which parameters are significant predictors of postoperative 5-year survival and to evaluate the effect of the predictors on clinical treatment in upper urinary tract transitional cell carcinoma. Methods: This study included 45 patients with transitional cell carcinoma of the upper urinary tract. Age, sex, symptoms, hemoglobin, blood transfusion, type of operation, histological grade, clinical stage, size, number, recurrence and PCNA index of tumor have been assessed by Cox's proportional hazards model. Results: Only the sympotoms(P=0. 0234), number(P=0. 0422), stage(P= 0. 0017) and PCNA index (P= 0.0001) were significant predictors and, to a lesser extent, the grade(P = 0. 0689). as well as the type of operation (P=0. 0598), The most impotant variables wer the stage and PCNA index According to the stage and PCNA index three groups were identified, and postoperaive 5-year survival rate were 92.6%, 38. 4 % and 3%, respectively, statistic difference were acquired. Conclusion:The study shows that stage and PCNA index were most important indicator in those prognostic factors, and number symptom. Grade and operative methods were also useful parameters. Stage together with PCNA index may stratified the patients into three distinct groups and that were useful for predictive of prognosis and planning management in patients with transitional cell carcioma of the upper urinary tract.