原发性输尿管癌淋巴转移情况及预后分析

Lymphatic metastasis and prognosis of primary ureteral carcinoma

目的：探讨不同部位原发性输尿管癌与淋巴结转移的关系，并对其预后进行分析。方法：对44例原发性输尿管癌患者的肿瘤及淋巴结标本进行病理学分析，对照输尿管肿瘤的位置，并对患者的预后进行随访。结果：44例原发性输尿管癌，16例发现有淋巴结转移癌，转移率为36．4％；其中输尿管上段癌23例，淋巴结转移癌5例，转移率为22．0％；输尿管下段癌21例，淋巴结转移癌11例，转移率52．0％，二者比较差异有统计学意义（P〈0．05）；随访6个月～10年，死亡9例（20．5％），局部复发或远处转移16例（36．4％），肿瘤进展率为56．8％；其中输尿管上段癌进展9例，肿瘤进展率36．0％，输尿管下段癌进展16例，肿瘤进展率64．0％，二者比较差异有统计学意义（P〈0．05）；术后发生膀胱癌12例，发生率27．3％，其中榆尿管上段癌术后出现5例，发生率41．7％，输尿管下段癌术后出现7例，发生率58．3％，二者比较差异无统计学意义（P〉0．05）。结论：原发性输尿管癌淋巴结转移率较高。输尿管下段癌更易发生淋巴转移，预后也较输尿管上段癌差。

Objective To discuss the lymphatic metastasis of the different part of ureteral cancer and its prognosis. Methods The tumor and lymph node specimen were analyzed pathologically in 44 cases of primary ureteral cancer. All the patients were followed up. Results In all the 44 cases, 16 cases had lymphatic metastasis. In 23 cases of upper part ureteral cancer, 5 cases （22. 0%） had lymphatic metastasis and, in 21 cases of lower part ureteral cancer, 11 cases（52.0%） had lymphatic metastasis（P〈0.05）. All the cases were followed up from 6 months to 10 years, sixteen patients had local recurrence or distant metastasis and 9 died （20.5%）, and the total progress rate was 56.8%. Among the 25 cases of progression, the upper part of ureteral carcinomas progressed in 9 cases （36.0%） and the lower part of ureteral carcinomas progressed in 16（64.0%） and there was a statistic difference （P〈0.05）. Conclusion The primary ureteral metastasis has more chance of lymphatic metastasis. The lower part of ureteral carcinoma has a higher lymphatic metastasis rate and a poor prognosis compared to the upper ureteral carcinoma.