影响原发性输尿管癌预后及其术后继发膀胱癌的多因素分析

Multifactor analysis of prognosis and the incidence of secondary bladder cancer in patients with primary ureteral carcinoma

目的:探讨影响原发性输尿管癌预后及其术后继发膀胱癌的危险因素。方法:回顾性分析58例2010年6月至2017年9月于重庆医科大学附属第一医院行手术治疗,病理诊断为输尿管癌患者的临床资料,对可能影响输尿管癌预后的7个临床及病理因素进行单因素和多因素Cox模型分析,对可能影响输尿管癌术后继发膀胱癌的5个临床及病理因素进行单因素和多因素Cox模型分析。结果:单因素分析表明:临床分期(χ2=16.441,P=0.000)、组织学分级(χ2=6.941,P=0.008)、术后是否化疗(χ2=4.934,P=0.026)与输尿管癌预后显著相关。性别(χ2=0.414,P=0.520)、年龄(χ2=2.013,P=0.156)、肿瘤是否多发(χ2=0.029,P=0.865)、手术方式(χ2=0.243,P=0.622)与预后无关。浸润深度(χ2=5.314,P=0.021)、术后膀胱灌注(χ2=3.919,P=0.048)、组织学分级(χ2=7.025,P=0.008)、手术方式(χ2=6.565,P=0.010)与输尿管癌术后继发膀胱癌显著相关。肿瘤是否多发(χ2=1.291,P=0.256)与输尿管癌术后继发膀胱癌无关。多因素分析表明:临床分期(RR=6.037,95%CI=1.708~21.333,P=0.005)及组织学分级(RR=10.032,95%CI=1.161~86.695,P=0.036)是影响输尿管癌预后的显著因素,高级别组织学分级(RR=8.942,95%CI=1.175~68.056,P=0.034)及非根治手术(RR=3.819,95%CI=1.424~10.244,P=0.008)是输尿管癌术后继发膀胱癌的危险因素(RR>1)。结论:输尿管癌的临床分期及组织学分级是决定预后的显著影响因素;组织学分级及手术方式是影响输尿管癌术后继发膀胱癌的显著独立危险因素。

Objective:To discuss the risk factors which influence prognosis and the incidence of secondary bladder cancer in patients with primary ureteral carcinoma. Methods:The clinical data of 58 patients were retrospectively analyzed. All patients were pathologically diagnosed with primary ureteral carcinoma in the First Affiliated Hospital of Chongqing Medical University from June,2010 to September,2017 and then treated by operation. Clinical and pathological factors,seven on prognosis and five on the incidence of secondary bladder cancer,were collected and analyzed with univariate analysis and multivariate analysis respectively. Results:Univariate analysis identified three factors that were associated with prognosis:clinical stage(χ^2=16.441,P=0.000),histological grade of tumor(χ^2=6.941,P=0.008),chemotherapy or not(χ^2=4.934,P=0.026). But age(χ^2=2.013,P=0.156),gender(χ^2=0.414,P=0.520),method of operation(χ^2=6.565,P=0.010)and multifocal or unifocal tumor(χ^2=0.128,P=0.720)showed no significant influence on prognosis. The depth of invasion(χ^2=5.314,P=0.021),bladder irrigation after operation(χ^2=3.919,P=0.048),histological grade of tumor(χ^2=7.025,P=0.008)and method of operation(χ^2=6.565,P=0.010)were significantly associated with the incidence of secondary bladder cancer. But multifocal or unifocal tumor(χ^2=0.336,P=0.562)had no statistical significance on the incidence of secondary bladder cancer. Multi-variate analysis identified the significant factors for prognosis of ureteral cancer were clinical stage(RR=6.037,95%CI=1.708 to21.333,P=0.005)and histological grade of tumor(RR=10.032,95%CI=1.161 to 86.695,P=0.036). The influencing factors on the incidence of secondary bladder cancer were high grade histological of tumor(RR=8.942,95%CI=1.175 to 68.056,P=0.034)and non radical operation(RR=3.819,95%CI=1.424 to 10.244,P=0.008). Conclusion:The significant factors for prognosis of ureteral cancer are clinical stage and histological grade of tumor. The significant influencing factors on the incidence of secondary bladder cancer after ureteral cancer are the method of operation and histological grade of tumor.