125I放射性粒子植入联合手术和化疗治疗局部晚期上尿路尿路上皮癌的疗效分析

The efficacy of 125I radioactive particle implantation combined with surgery plus chemotherapy in the treatment of locally advanced upper tract urothelial carcinoma

目的探讨125I放射性粒子植入联合手术和化疗治疗局部晚期上尿路尿路上皮癌（UTUC）的疗效。 方法回顾性分析2006年1月至2012年12月收治的128例采用手术＋放射性粒子植入＋术后GC方案化疗（试验组）和手术＋术后GC方案化疗（对照组）治疗局部晚期（T3～T4期）UTUC患者的临床资料。所有患者均手术完整切除肿瘤，术后病理均为尿路上皮癌。试验组65例，男45例（69.2%），女20例（30.8%）；年龄46～80岁，中位年龄56.5岁；肾盂癌39例（60.0%），其中局部淋巴结转移13例（33.3%），输尿管癌26例（40.0%），其中局部淋巴结转移11例（42.3%）。对照组63例，男46例（73.0%），女17例（27.0%）；年龄47～81岁，中位年龄57.1岁；肾盂癌40例（63.5%），其中局部淋巴结转移12例（30%），输尿管癌23例（36.5%），其中局部淋巴结转移10例（43.4%）。两组基线数据比较差异无统计学意义（均P〉0.05）。比较两组局部肿瘤复发和远处转移率、无远处转移生存（DDFS）率、疾病特异性生存（DDS）率、总生存（OS）率及不良反应。 结果两组患者随访5～62个月，中位时间为50.5个月。试验组患者术后6个月、1年、2年、3年、5年肿瘤累积复发和远处转移分别为2例、5例、11例、16例、21例，5年累积复发和远处转率32.3%（21/65）。对照组患者术后6个月、1年、2年、3年、5年肿瘤复发和远处转分别为3例、5例、17例、21例、32例，5年累积复发和远处转移率为50.8%（32/63），两组比较差异有统计学意义（P＝0.034）。试验组和对照组5年DDFS率分别为61.5%（40/65）和41.3%（26/63），差异有统计学意义（P＝0.022）；5年DDS率分别为69.2%（45/65）和50.8%（32/63），差异有统计学意义（P＝0.033）；5年OS率分别为53.8%（35/65）和36.5%（23/63），差异有统计学意义（P＝0.049）。 结论与手术加化疗相比，采用125I放射性粒子植入联合手术加化疗治疗局部晚期（T3～T4期）UTUC能够取得生存获益，且粒子植入的不良反应较小，安全、有效。

ObjectiveTo investigate the efficacy of 125I radioactive particle implantation combined with surgery and chemotherapy in the treatment of locally advanced urinary tract urothelial carcinoma （UTUC）. MethodsThe clinical data of 128 patients of locally advanced （T3, T4） UTUC treated with surgery with radioactive particle implantation plus postoperative GC chemotherapy（experimental group） and surgery plus postoperative GC chemotherapy （control group） were retrospectively analyzed. All the patients underwent complete resection of the tumor. The postoperative pathology was urinary tract epithelium cancer. In the experimental group, there were 45 （69.2%） males and 20 （30.8%） females, with median age 56.5 years. There were 39 （60.0%） patients diagnosed with renal pelvic cancer, including 13（33.3%） patients with local lymph node metastasis; 26 patients （40.0%） with ureteral cancer, 11 patients （42.3%） with local lymph node metastasis. In the control group, there were 46 males （73.0%） and 17 females （27.0%）, with median age 57.1 years. There were 40 （63.5%） patients with renal pelvic cancer, including 12（30%） cases of local lymph node metastasis; 23 patients with ureteral carcinoma （36.5%）, including 10 patients （43.4%） with local lymph node metastasis. There was no significant difference in baseline data between the two groups （ P〉0.05）. The recurrence and distant metastasis, recurrence-free survival, distant disease free survival（DDFS）, disease-specific survival（DSS）, overall survival （OS） and complications of two groups were compared. ResultsThe follow-up time was 50.5 months（ranged 5 to 62 months）. In experimental group, there were 2 cases, 5 cases, 11 cases, 16 cases and 21 cases occurred recurrence and distant metastasis in 6 months, 1 year, 2 years, 3 years and 5 years respectively, and the 5-year cumulative recurrence and distant rate was 32.3%（21/65）. In control group, there were 3 cases, 5 cases, 17 cases, 21 cases and 32 cases, occurred recurrence and distant metastasis in 6 months, 1 year, 2 year, 3 year, 5 year respectively, and the 5-year cumulative recurrence and distant rate was 50.8%（32/63）. There was significant difference between the two groups （P=0.034）. In the experimental group and the control group, the 5-year non-metastatic survival rates were 61.5%（40/65）and 41.3%（26/63）, respectively. There was significant difference in 5-year non-metastatic survival rate between the two groups （P=0.033）. The 5-year DSS rates were 69.2%（45/65）and 50.8%（32/63）, respectively. The 5-year DSS rate of the two groups was significantly different （P=0.033）. The 5-year OS rates were 53.8%（35/65）and 36.5%（23/63） respectively. There was significant difference in the 5-year OS rate between the two groups （P=0.049）. ConclusionsCompared with surgery and chemotherapy, the use of 125I radioactive particle implantation combined with surgery and chemotherapy in the treatment of locally advanced stage （T3-T4） UTUC could achieve the total survival benefit, and less adverse reactions.