中国上尿路尿路上皮癌人群特征和地区差异：基于CUDA-UTUC协作组的多中心研究

Characteristics and regional difference of Chinese upper tract urothelial carcinoma patients： a multi-center study by CUDA-UTUC Collaborative Group

目的分析我国不同地区上尿路尿路上皮癌（UTUC）患者临床特征的差异，探讨影响患者预后的危险因素。 方法回顾性分析1998年1月至2013年1月中国三大地区共9个中心的2 628例UTUC患者（北京2个中心共1 022例，上海1个中心共814例，四川6个中心共792例）的临床资料。患者年龄20～93岁，平均66.3岁；男1 447例（55.1%），女1 181例（44.9%）。按照地区南方（上海加四川）、北方（北京）进行划分，分析患者的临床病理特征和影响预后的危险因素。 结果2 628例术后病理分期为Ta＋ T1、T2、T3、T4的患者分别为914例（34.8%）、715例（27.2%）、857例（32.6%）及142例（5.4%）。北方患者的女性比例[55.9%（571/1 022）]和输尿管肿瘤比例[43.4%（444/1 022）]高于南方患者[38.0%（610/1 606）和35.9%（577/1 606），P〈0.001]，南方患者的高分期（≥T3期）比例[42.5%（682/1 606）]和高级别比例[72.0%（1 156/1 606）]高于北方患者[31.0%（317/1 022）和34.0%（347/1 022），P〈0.001]，且肿瘤最大径[（3.73±2.17）cm]大于北方患者[（3.36±2.02）cm，P〈0.001]。亚组分析结果显示，在北方患者中女性肿瘤分期低于男性[≥T3期的比例分别为27.2%（155/571）与35.9%（162/451），P＝0.014]，而南方患者中女性的分期高于男性[≥T3期的比例分别为48.2%（294/610）与38.9%（388/996），P＝0.004]。2 628例患者随访1～206个月，中位时间41个月，963例（36.6%）死亡，其中肿瘤特异性死亡815例（31.0%）。在北方患者中，女性与男性的5年总生存率（75.5%与62.2%，P〈0.001）和肿瘤特异性生存率（78.3%与65.0%，P〈0.001）差异均有统计学意义，而南方患者女性与男性的5年总生存率（58.5%与60.1%，P＝0.927）和肿瘤特异性生存率（62.0%与65.8%，P ＝0.345）差异均无统计学意义。 结论中国UTUC患者中北方人群相较于南方人群具有肿瘤分期和分级较低、女性患者较多、女性患者预后较好的特征。高龄、较大的肿瘤直径、高分期、高分级、存在淋巴结转移和淋巴血管侵犯是影响中国UTUC患者预后的危险因素。

ObjectiveTo illustrate the clinical and pathological features of Chinese upper tract urothelial carcinoma （UTUC） patients and to investigate the regional difference and the possible prognostic factors. MethodsA retrospective study was performed on 2 628 patients from 9 centers of three different regions （Beijing： 2 centers with 1 022 cases, Shanghai： 1 center with 814 cases, Sichuan： 6 center with 792 cases）. The median age was 68 （range 20 to 93） and the mean age was 66.3. There were 1 447 male patients （55.1%） and 1 181 female patients （44.9%）. The clinical information, pathological outcomes and prognosis were collected and analyzed based on South （Shanghai and Sichuan） and North （Beijing） region. ResultsThe distribution of Ta＋ T1, T2, T3 and T4 was 914（34.8%）, 715（27.2%）, 857（32.6%） and 142（5.4%）. Patients from North were more likely to be female （55.9% vs. 38.0%, P〈0.001） and suffer from ureteral tumors （43.4% vs. 35.9%, P〈0.001）; while in patients from South higher tumor stage（T3 or T4, 42.5% vs. 31.0%, P〈0.001 ）, high grade（72.0% vs. 34.0%, P〈0.001） and larger tumor size [（3.73±2.17） cm vs. （3.36±2.02） cm, P〈0.001] were more prevalent. Subgroup indicated that female patients in North had obviously lower tumor stage （T3 or T4, 27.2% vs. 35.9%, P=0.014）, while relatively higher tumor stage were noticed in female patients in South （T3 or T4, 48.2% vs. 38.9%, P=0.004）. The median follow-up was 41（1-206） months, and 963 patients （36.6%） died including 815 （31.0%） died from cancer. In North female patients had better 5-year overall survival （75.5% vs. 62.2%, P 〈0.001） and cancer-specific survival （78.3% vs. 65.0%, P〈0.001）, but in South gender had no impact on overall survival （58.5% vs. 60.1%, P=0.927） or cancer-specific survival （62.0% vs. 65.8%, P=0.345）. ConclusionsThis study demonstrated that in Chinese patients with UTUC, those from North were featured for lower tumor stage and grade, higher proportion of females and females had better survival. High age, high tumor stage and grade, large tumor diameter, and the presence of lymph node metastasis or lymphovascular invasion were risk factors for poor prognosis in Chinese UTUC patients.