UTUC根治术后膀胱癌复发的危险因素及预后

Risk factors and prognosis of bladder recurrence after radical nephroureterectomy for UTUC

目的探讨上尿路尿路上皮癌(upper tract urothelial carcinoma,UTUC)根治术后膀胱癌复发的危险因素及预后。方法收集208例根治术后经病理确诊且具有完善临床病理资料及随访信息的UTUC病例,分析肿瘤复发与各临床病理参数及预后的相关性。结果 208例UTUC患者中男性67例,女性141例,男∶女为1∶2.1。根治术后膀胱癌复发23例(11.1%),中位复发时间18月,更多见于男性患者(P=0.027),复发与否患者在组织学级别方面差异有统计学意义(P=0.001)。有膀胱癌病史(46.2%,P=0.006)或同时合并膀胱癌(33.3%,P=0.030)的UTUC患者再次膀胱癌复发概率明显升高。生存分析结果显示,膀胱癌复发与否患者在总生存期(P=0.145)及无瘤生存期(P=0.215)方面比较差异均无统计学意义。结论影响UTUC根治术后膀胱癌复发的危险因素为性别及组织学级别。术前有膀胱癌病史或同时合并膀胱癌的患者再次膀胱癌复发的概率升高。膀胱癌复发与否对患者的总生存期及无瘤生存期无明显影响。

Objective To evaluate the risk factors and prognosis of bladder recurrence in patients with upper tract urothelial carcinoma（ UTUC） after radical nephroureterectomy（ RUN）. Methods Complete clinicopathological and follow-up data of 208 cases of pathologically confirmed UTUC after RUN was reviewed retrospectively. The relationship of tumor recurrence with clinicopathological features and prognosis of the disease was analyzed. Results Among 208 enrolled patients,67 cases were males and 141 were female with gender ratio of 1∶ 2. 1. Bladder recurrence developed after RUN in 23 cases（ 11. 1%） with a median recurrence time of 18 months. Bladder recurrence was more common in male patients（ P= 0. 027） and patients with lower tumor grade（ P = 0. 001）. The recurrence rate was significantly increased in UTUC patients with a history of bladder cancer（ 46. 2%,P = 0. 006） or combined with bladder cancer（ 33. 3%,P = 0. 030）. Nevertheless,survival analyses indicated that intravesical recurrence was not statistically correlated with overall survival（ OS,P =0. 145） or disease-free survival（ DFS,P = 0. 215）. Conclusion Male sex,low histological grade,history or concurrence of bladder cancer are risk factors of bladder recurrence after RUN in UTUC patients. Bladder recurrence has no significant effect on the OS or DFS of UTUC patients.