非肌层浸润性上尿路尿路上皮癌5年随访生存分析及其预后相关因素研究

The prognostic factors and predictive model of non-muscle invasive upper tract urothelial carcinoma：a survival analysis based on follow up over 5 years

目的 分析非肌层浸润性上尿路尿路上皮癌（non-muscle invasive upper tract urothelial carcinoma,NMIUTUC）患者长期生存情况及其相关预后因素,并构建基于中国人群的列线图模型.方法 回顾性分析2000年1月至2013年12月收治的253例NMIUTUC患者的临床和随访资料,男100例,女153例.年龄25～ 90岁,平均67岁.肾盂癌127例,输尿管癌126例.多发肿瘤65例,单发肿瘤188例.肿瘤长径＞5 cm者237例,≤5 cm者16例.乳头状肿瘤243例,非乳头状肿瘤10例.合并同侧肾积水147例.淋巴结转移6例.行腹腔镜手术162例,开放手术91例.行肾输尿管全长切除术244例,输尿管部分切除术9例.结果 本组253例随访4 ～ 151个月,中位时间55个月.40例（15.8％）死于肿瘤,84例（33.2％）出现膀胱复发.淋巴结转移（P =0.046）,原发灶位于肾盂（P =0.044）,合并同侧肾积水（P =0.039）,合并慢性肾脏病（P =0.008）和男性（P =0.034）为NMIUTUC患者术后肿瘤特异性死亡的独立危险因素.而肿瘤多发（P =0.018）,合并同侧肾积水（P =0.035）的患者更易出现术后膀胱复发.构建的用于预测NMIUTUC患者术后肿瘤特异性生存率的列线图模型的一致性指数为0.72.结论 NMIUTUC患者术后肿瘤特异性生存良好,膀胱复发率与肌层浸润性上尿路尿路上皮癌相当,且复发较晚.淋巴结转移、原发灶位于肾盂、合并同侧肾积水、合并慢性肾脏病和男性为术后肿瘤特异性死亡的独立危险因素.肿瘤多发、合并同侧肾积水的患者更易膀胱复发.

Objective to evaluate the prognostic factors of non-muscle invasive upper tract urothelial carcinoma （NMIUTUC） and construct prognostic model for Chinese patients.Methods A retrospective study including 253 patients who were diagnosed with NMIUTUC in our hospital and received Radical nephroureterectomy （RNU） or partial ureterectomy during January of 2000 to December of 2013.Of all the 253 patients,100 were male and 153 were female,average age was 67 （range：25-90）,244 received RNU and 9 received partial ureterectomy.Results The median follow-up time was 55 （range：4-151） months,and during follow-up,40 （15.8%） patients were died for cancer,84 （33.2%） patients developed intravesical recurrence.The independent prognostic factors of cancer-specific mortality were lymph nodes metastasis （P =0.046）,main tumor locate in pelvis （P =0.044）,ipsilateral hydronephrosis （P =0.039）,higher chronic kidney disease （CKD） stage （P =0.008） and male gender （P =0.034）,while patients with multifocality tumor or ipsilateral hydronephrosis more likely developed intravesical recurrence.Conclusion NMIUTUC has a better cancer-specific survival,the intravesical recurrence was equivalent to UTUC but later.Lymph nodes metastasis,main tumor locate in pelvis,ipsilateral hydronephrosis,CKD stage and male gender independently associated with cancer-specific mortality,while patients with multifocality tumor or ipsilateral hydronephrosis more likely developed intravesical recurrence.