影响肾盂输尿管癌预后的多因素分析

Multiplicity of prognostic factors in renal pelvic and ureteral carcinoma

目的探讨影响肾盂输尿管癌患者的预后因素。方法回顾性分析220例经病理证实的肾盂输尿管癌患者资料。男146例，女74例。年龄38-84岁。肾盂癌103例，输尿管癌84例，肾盂癌合并输尿管癌13例，肾盂癌合并膀胱癌5例，输尿管癌合并膀胱癌11例，肾盂癌、输尿管癌、膀胱癌同时发生4例。TNM分期：L2例、T1 116例、T2 48例、T3 37例、T4 17例；WHO分级：G1 5例、G2 87例、G3 28例。选择11个对预后可能产生影响的因素，应用Cox比例风险回归分析各因素与术后生存率的关系，生存率分析采用Kaplan-Meier方法。生存分析比较采用Gehan比分检验和Log-rank时序检验。应用logistic回归分析各因素与术后再发膀胱癌的关系。结果Ta～T1患者5年生存率为80．5％（95／118），T2为70．8％（34／48），T3为45．9％（17／37），T4为17．6％（3／17），Ta～T1、T2与T3～T4之间比较差异有统计学意义（Χ^2=9．429，P=0．002）。输尿管肾镜术治疗组生存率与其他手术组生存率分析比较，差异无统计学意义（Χ^2=0．217，P=0．641）。影响肾盂输尿管癌患者长期生存率的因素为年龄（RR=1．639，P=0．027）、症状初发到手术时间（RR=1．279，P=0．019）、肿瘤分期（RR=1．373，P=0．011）。与术后再发膀胱癌显著相关的因素是肿瘤多部位生长（RR=11．292，P=0．003）及伴发膀胱癌（RR=8．780，P=0．001）。结论年龄、症状初发到手术时间、肿瘤分期是影响肾盂输尿管癌患者长期存活的危险因素，肿瘤多部位生长及伴发膀胱癌是术后再发膀胱癌的高风险因素。

Objective To evaluate the prognostic factors for survival in patients with renal pelvic and ureteral carcinoma. Methods The clinical data of 220 patients with renal pelvic and/or ureteral carcinoma were retrospectively analyzed. One hundred and forty-six cases were males and 74 cases were females. Age ranged from 38 to 84 years. One hundred and three cases were renal pelvic carcinoma, 84 cases were carcinoma of ureter, 13 cases were renal pelvic carcinoma with carcinoma of ureter, 5 cases were renal pelvic carcinoma with bladder cancer, 11 cases were carcinoma of ureter with bladder carcinoma, and 4 cases were renal pelvic carcinoma with carcinoma of ureter and bladder carcinoma. For TNM stage, there were 2 cases in Ta, 116 cases in T1 , 48 cases in T2, 37 cases in T3 and 17 cases in T4. For WHO grade, there were 5 cases with grade Ⅰ tumor, 87 cases with grade Ⅱ tumor and 128 cases with grade Ⅲ. Multivariate analyses were done using logistic analysis and Cox proportional hazards regression model with Kaplan-Meier method, Log-rank test and Gehan test, respectively. Results The 5-year survival rates of Ta--T1 , T2 , T3, T4 cases were 80.5%（95/118）, 70.8%（34/48）, 45. 9% （17/37） and 17.6% （3/17）, respectively. Survival rates were significantly different in patients with tumor stage Ta- T1, T2 and patients with tumor stage T3--T4 （u= 9. 429, P=0. 002）. There was no significant difference between survival of ureterorenoscopic surgery group and other operation group（Χ^2 = 0. 217, P=0. 641）. The factors affected survival were age （RR= 1. 639,P=0. 027）, time of initial symptoms to operation （RR=1. 279,P=0. 019） and clinical stage of the tumor （RR= 1. 373,P= 0. 011）. Logistic regression analysis showed that the factors influencing the recurrence of bladder carcinoma included multi site growth（RR= 11. 292, P= 0. 003）and coexisting bladder carcinoma （RR=8. 780,P=0. 001）. Conclusions Age, time of initial symptoms to operation and the stage of the tumor are the important predictors affecting the prognosis of the renal pelvic and ureteral carcinoma. Multi-site growth and coexisting bladder carcinoma are important risk factors having impact on the recurrence of bladder carcinoma.