术中联合^(125)I粒子植入治疗中晚期肾盂输尿管癌疗效分析

Effects of surgical ^(125)I radioactive seed implantation for the treatment of moderate or advanced renal pelvis ureter carcinoma

目的探讨术中联合125I粒子植入治疗中晚期肾盂、输尿管尿路上皮癌(UUTUC)的疗效。方法回顾分析2004—2009年50例肾盂、输尿管移行细胞癌患者的临床资料。粒子植入组20例行术中直视下瘤床组织间125I粒子植入,单纯手术组30例单纯根治性手术。局部控制率、生存率用Kaplan-Meier法计算并Log-rank法检验及单因素分析,多因素分析采用Cox回归模型。结果单纯手术组、粒子植入组局部复发率分别为37%和10%,差异有统计学意义(P<0.05)。2组生存率无明显差异。单因素和多因素分析显示分期(χ2=15.89,P=0.000)、脉管癌栓(χ2=3.92,P=0.048)与总生存率有关。结论术中联合125I粒子植入治疗中晚期肾盂、输尿管尿路上皮癌是简单、安全、有效的方法,可降低局部复发率,但在改善患者生存方面尚未现优势。T分期较晚及脉管癌栓是预后不良因素。

Objective To determine the efficacy of surgical 125↑I radioactive seed implantation for the treatment of moderate or advanced renal pelvis-ureter-urinary tract carcinoma.Methods We retrospectively reviewed the clinical profiles of 50 patients with transitional cell carcinoma of the renal pelvis or ureter who were recruited between 2004 and 2009.Patients in group A（n=20） received visual-guided surgical 125I radioactive seed implantation therapy while those in group B（n=30） were treated with radical resection.The local control and survival rates were calculated by Kaplan-Meier approach and tested by Logrank test,and Cox model was employed for the univariate and multivariate analysis.Results A significantly higher rate of relapse was noted in group B（36.7% vs 10%,P〈0.05）.The difference in the survival rate did not reach statistical difference（P〈0.05）.Univariate and multivariate analyses showed that the stage of tumor（χ2=15.89,P=0.000） and vascular invasion（χ2=3.92,P=0.048） correlated with overall survival rate.Conclusion Featured by simplicity,safety and effectiveness,the surgical 125↑I radioactive seed implantation therapy reduces the rate of local relapse yet may not warrant superiority in terms of improved survival rate for the treatment of moderate or advanced renal pelvis and ureteral urothelial carcinoma.Advanced T stage and vascular invasion are associated with poor prognosis.