上尿路移行细胞癌术后发生膀胱癌的危险因素分析

Risk factors of the occurrence bladder tumor after resection of upper urinary tract urothelial carcinoma

目的 探讨上尿路移行细胞癌临床与病理特点及对术后膀胱癌发生及预后的影响。 方法 对 133例肾盂和 (或 )输尿管癌病例的临床特点与术后发生膀胱癌以及预后情况分别应用Cox比例风险模型分析 ,作Kaplan Meier曲线并行LogRank检验。 结果 133例患者接受根治手术后发生膀胱癌者 40例 ,占 30 .1%。原发上尿路肿瘤数目、分期和有无同发膀胱癌对术后发生膀胱癌有显著影响 ,风险度 >1,回归系数 >0 ,二者间相关系数小。应用LogRank检验显示原发肿瘤为单发者术后无膀胱癌发生的机率低于多发者 (P =0 ) ,随着病理分期的升高 ,膀胱癌发生率随之增加 (P =0 .0 0 39)。首次发生膀胱癌者有 92 .5 %在 2年之内。原发肿瘤数目、分期、有无同发膀胱癌以及术后膀胱癌发生间隔时间对存活率有显著影响 ,四种因素的相关系数小。 结论 原发上尿路肿瘤的数目、分期和有无同发膀胱癌为术后发生膀胱癌的危险因素 ;原发肿瘤数目、分期。

Objective To study the clinicopathological features and prognosis of upper urinary tract transitional cell cancer with intravesical occurrence. Methods 133 cases of transitional cell renal cancer were retrospectively studied.Cox's analysis,kaplan Meier function and log rank test were used to assess the influence of clinicopathological features to the intravesical occurrence of the cancer. Results There were 40 cases of bladder involvement of the cancer out of 133 after kidney ureter and partial bladder resection.The number and the stage of the primary cancer,with concurrent bladder cancer of not were significantly related to the occurrence of intravesical occurrence of the cancer after surgical management.The hazard ratio(>1),regression coefficient(>0) and the correlation coefficient were low.The absence of intravesical occurrence of the cancer in solitary primary tumor cases was significantly less than that in the multiple ones ( P =0).The intravesical occurrence rate of the cancer elevated with the pathological stage of the primary cancer ( P =0.0039).92.5% of cases with initial concurrent involvement of the bladder have had the occurrence of bladder cancer within 2 years after surgical treatment. Conclusions The number and the stage of the primary tumor,with concurrent bladder involvement or not and the internal between the occurrence of the bladder cancer and the upper urinary tract cancer are the significant factors for prognosis,the coefficient correlation between the 4 factors being low.