单中心尿路上皮癌2 115例临床特点分析

Clinical analysis of 2 115 urothelial carcinoma： single-center experience

目的 统计单中心尿路上皮癌的临床特点. 方法 回顾性总结2003年1月至2012年12月北京协和医院收治的2115例尿路上皮癌患者的临床资料.膀胱癌1414例（66.9％）、输尿管癌329例（15.5％）、肾盂癌372例（17.6％）.分析不同年龄段、不同性别及城乡患者中膀胱癌、输尿管癌及肾盂癌的分布情况和病理分级分期差异. 结果 膀胱癌、输尿管癌和肾盂癌病理分级为低级别者分别占83.5％、68.7％和46.5％,非肌层浸润性者分别占84.9％、74.8％和59.7％,组间比较差异均有统计学意义（P=0.000）.膀胱癌及肾盂癌以男性居多,输尿管癌以女性居多,各部位尿路上皮癌的男女比差异有统计学意义（P=0.000）,尿路上皮癌、膀胱癌、输尿管癌和肾盂癌中男女患者的病理分级、分期比较差异均无统计学意义（P＞0.05）.患者年龄分布主要在41～80岁,共1 898例（89.7％）,青年（≤44岁）与中老年（≥45岁）组两个年龄段尿路上皮癌病理分级、分期比较差异有统计学意义（P＜0.05）.各部位尿路上皮癌患者城乡分布比较差异无统计学意义（P=0.127）.农村患者高级别癌及肌层浸润性癌比例均高于城镇患者,二者分级、分期比较差异均有统计学意义（P=0.027,P=0.002）.多部位尿路上皮癌129例（6.1％）,其中高级别89例（70.0％）,肌层浸润性癌62例（48.1％）.多部位与单部位尿路上皮癌肿瘤分级、分期比较差异有统计学意义（P=0.000）. 结论 在我院近10年尿路上皮癌中,膀胱癌比例最高,输尿管癌与肾盂癌具有更高比例的病理高级别和高分期.41～80岁患者比例较高,各部位尿路上皮癌病理分级分期与年龄呈正相关,而与性别无明显相关性,农村患者中高级别高分期的病例较多,多部位尿路上皮癌的恶性程度高.

Objective To investigate the clinical features of urothelial carcinoma in a single center.Methods The clinical data of 2 115 urothelial carcinoma patients admitted to Peking Union Medical College Hospital from January 2003 to December 2012 were reviewed retrospectively.Of the 2 115 patients,1414 cases were bladder carcinoma,329 cases were ureter carcinoma and 372 cases were renal pelvic carcinoma.Statistical method was used to analyze the differences of distribution and pathological grading and staging of bladder,ureter and renal pelvic carcinoma among different ages,genders,and urban and rural patients.Results The proportion of low-grade carcinoma was 83.5％ for bladder,68.7％ for ureter and 46.5％ for renal pelvic carcinoma,and the proportion of non-muscle invasive carcinoma was 84.9％,74.8％ and 59.7％ respectively,and significant difference was found in pathological grading and staging among the three groups （P =0.000）.In bladder and renal pelvic carcinoma patients,males were common,while females were more common in ureter carcinoma patients.There was significant difference in gender among the three groups （P =0.000）,while there was no significant difference in pathological grading and staging between male and female patients（P＞0.05）.89.7％ （1 898 cases） were concentrated in the 41-80 years old.The grading and staging of urothelial carcinoma in young,middle-aged and elderly groups showed significant difference （P＜ 0.05）.The proportions of high-grade and muscle invasive urothelial carcinoma patients in rural areas were both higher than that in urban areas,the difference in pathological grading and staging between urban and rural patients was significant （P＜0.05）.Of the 129 cases （6.1％） with multifocal urothelial carcinoma,there were 89 cases （70.0％） with high grade and 62 cases （48.1％） with muscle invasive carcinoma.Significant difference was found in pathological grading and staging between multifocal and single urothelial carcinoma （P=0.000）.Conclusions In the uretholial carcinoma of Peking Union Medical College Hospital in the past ten years,the proportion of bladder carcinoma is the highest,while ureter and renal pelvic carcinoma have higher proportion of high grade and stage.The proportion of patients in the 41-80 years old is higher.The pathological grading and staging of urothelial carcinoma is positively correlated with age,but there is no significant correlation in gender.The patients with high grade and stage carcinoma in rural areas are more than that in urban areas.Multifocal urothelial carcinoma has higher malignancy.