上尿路移行细胞癌预后的多因素分析

Multivariate analysis of prognosis of patients with upper urinary tract transitional cell carcinoma

目的:通过对71例上尿路移行细胞癌患者临床资料的回顾性分析,评价上尿路移行细胞癌的预后情况,探讨影响上尿路移行细胞癌生存预后的因素。方法:收集2004年2月至2007年1月行根治性肾输尿管全长切除术治疗的上尿路移行细胞癌患者71例,对所有病例进行病史采集,包括年龄、性别、肿瘤位置、大小、手术侧、手术方式、肿瘤分级、肿瘤分期及部分病理学指标(包括p53、Ki-67、nm23、C-erB-2)等。术后进行电话或门诊随访,每月1次,了解患者术后生存情况。Kaplan-Meier乘积极限法计算生存率,Cox比例风险模型分析影响生存预后的因素。结果:本组患者1、2和3年疾病特异生存率分别为95.8%、89.3%和83.5%。Cox多因素分析结果表明,仅肿瘤分期是影响患者预后的因素。结论:肿瘤分期是影响上尿路移行细胞癌生存的独立的预后因素。后腹腔镜手术在肿瘤控制方面与开放手术无明显差别,但长期疗效有待进一步观察。

Objective：To retrospectively analyze the clinical data of 71 patients with upper urinary tract transitional cell carcinoma （UUT-TCC）, so as to assess the prognosis of patients and search for factors influencing the prognosis of patients. Methods： Totally 71 UUT-TCC patients treated surgically from FeE. 2004 to Jan. 2007 were included in this study. All patients underwent radical nephroureterectomy via retroperitoneoscopic approach or open approach. The patients were followed up once a month after operation. Traditional prognostic factors including age, sex, tumor stage, grade, location, type of surgical treatment and some pathological biomarkers, such as p53, Ki-67, nm23, and C-erB-2, were collected and analyzed with respect to disease-specific survival by Kaplan-Meier method. Predictive factors influencing the disease-specific survival were also analyzed by Cox proportional hazards model. Results： The 1-, 2- or 3-year disease^specific survival rates were 95.8%, 89.3% and 83.5%, respectively. Only tumor stage was found to be a factor for prognosis by multivariate analysis （P〈0. 001）. Conclusion： Tumor stage is an independent predictor nephroureterectomy achieves similar outcomes to the traditional of disease-specific survival. Retroperitoneoscopic radical open surgery on oncology control, with the long-term outcome remains to be further studied.