保留肾单位手术治疗低级别、低分期上尿路上皮癌的临床分析

Nephron-sparing management for low grade,low stage upper tract urothelial carcinoma

目的 通过比较根治性肾输尿管及膀胱袖状切除术和保留肾单位手术方式治疗低级别（≤G2）、低分期（＜pT2）上尿路上皮癌患者的临床疗效及预后,探讨保留肾单位手术治疗低级别、低分期上尿路上皮癌的临床应用价值.方法 回顾性分析安徽省立医院1993年1月1日-2013年1月1日收治的173例低级别、低分期上尿路上皮癌病例资料.按照采用的手术方式分为根治性肾输尿管及膀胱袖状切除术组（A组）和保留肾单位手术组（B组）.采用两独立样本t检验和x2检验比较两组患者的年龄、性别、肿瘤部位（肾盂、输尿管）、肿瘤分期与分级差异,Kaplan-Meier生存分析进行术后5年肿瘤的复发率、转移率和生存率,并采用Log-rank检验进行比较.结果 两组手术均获得成功,术后病理为移行细胞癌.158例（91.3％）获得随访,随访时间为6-60个月,平均（51.57±13.69）个月.两组患者的年龄（t=1.450,P=0.149）、性别（x2=0.054,P=0.816）、肿瘤部位（x2 =2.628,P=0.105）、肿瘤分期（x2 =2.030,P=0.154）与分级（x2 =0.032,P=0.858）差异均无统计学意义;A、B两组患者术后5年无复发生存率分别为77.5％（99/128）和72.3％（33/45）,5年无转移生存率分别为88.9％（114/128）和81.9％ （37/45）,5年特异性生存率分别为94.2％（121/128）和89.0％ （40/45）,差异均无统计学意义.结论 对于低级别、低分期上尿路上皮癌,保留肾单位手术与根治性肾输尿管及膀胱袖状切除术具有相似的临床疗效及预后效果.因此,采用创伤小的保留肾单位手术方式治疗低级别、低分期上尿路上皮癌具有较好的临床应用价值.

Objectives To explore the clinical value of nephron-sparing measures （NSM） for Low Grade （≤ G2）,Low Stage （〈 pT2） Upper Tract Urothelial Carcinoma （UTUC） patients.Methods Retrospective analysis of 173 clinical cases of low grade and low Stage UTUC patients from January 1993 to January 2013.Group A：128 patients who underwent radical nephroureterectomy （RNU） with excision of the bladder cuff; Group B：45 patients who underwent NSM.Comparisons between groups were assessed using the Student t test for continuous variables and the chi-square test for categorical variables.Kaplan Meier method as well as Long-rank test are used to analyse the diversity in 5-years recurrence,metastasis and survival rate between two groups.Results Operations were performed successfully in both groups,postoperative pathological findings confirmed the diagnosis of transitional cell carcinoma.158 cases （91.3%） were followed up for6 - 60（51.57 ± 13.69）months.There was no statistical difference between the group A and group B for age（P =0.149）,gender（P =0.816）,tumor location（P =0.105）,tumor stage（P =0.154） and grade（P =0.858）,There was no statistical difference between the group A and group B for the 5-year probability of recurrence-free survival（P =0.517）,metastasis-free survival（P =0.237） and cancer-specific survival（P =0.282） either.Conclusions NSM was comparable to RNU with excision of the bladder cuff for the management of Low Grade,Low Stage UTUC.This study may have reference significance for the treatment of patients with UTUC.