马兜铃酸肾病合并上尿路上皮癌患者的预后分析

The prognosis of patients with aristolochic acid nephropathy complicated with upper tract urothelial carcinoma

目的研究马兜铃酸肾病(AAN)合并上尿路尿路上皮癌(UTUC)患者的预后。方法收集AAN合并UTUC患者(AAN组)42例作为研究对象,连续选取同期238例非AAN伴UTUC患者(非AAN组)作为对照组,所有患者均行单侧根治性手术,比较两组一般情况及术后预后。结果两组患者在性别、年龄、肿瘤位置、合并同侧肾积水、及肿瘤分期上的差异无统计学意义。AAN组平均手术时间(142.3.3±26.4)min,非AAN组平均手术时间(146.0±32.5)min(P>0.05)。AAN组术中估计出血量(207.8±78.3)mL,而非AAN合并组估计出血量(194.5±90)mL(P>0.05)。AAN组死亡22例,总生存率为47.6%;非AAN组死亡78例,总生存率为67.2%,二者之间差异有统计学意义(P=0.014)。其中AAN组有10例死于尿路上皮癌,其疾病特异性生存率76.2%,非AAN组有35例死于尿路上皮癌,其疾病特异性生存率85.3%(P=0.091)。两组无瘤复发生存率分别为40.5%、64.7%,组间差异有统计学意义(P=0.001)。结论 AAN合并UTUC组无瘤复发生存率及总生存率明显低于非AAN伴UTUC患者,但两者疾病特异性生存率差异无统计学意义。

Objective To explore the prognosis of patients with upper tract urothelial carcinoma （UTUC） complicated with aristolochic acid nephropathy （AAN）. Methods The clinical data of 42 UTUC patients with AAN （AAN group） and 238 UTUC patients without AAN （non-AAN group） were analyzed.All patients underwent radical nephroureterectomy with excision of bladder.The preoperative and intraoperative indexes,and clinical outcomes of the two groups were compared. Results There were no significant differences in age,sex,location of tumor,hydronephrosis,tumor stage and tumor grade between the two groups.In the AAN group and non-AAN group,the average operation time in was （142.3.3±26.4）min and （146±32.5）min （ P 〉0.05）; the estimated blood loss was （207.8±78.3）mL and （194.5±90）mL （ P 〉0.05）; the overall survival rate was 47.6 % and 67.2 % （ P =0.014）; the disease specific survival rate was 76.2 % and 85.3 % （ P =0.091）; the recurrence-free survival rate was 40.5 % and 64.7 % （ P 〈0.001）. Conclusion The overall survival rate and the recurrence-free survival rate of UTUC patients with AAN are significantly lower than those of UTUC patients without AAN,The UTUC patients with ANN difference in disease specific survivan but there was no significant between the two groups.