上尿路尿路上皮癌根治术后早期(≤1年)出现远处转移的危险因素分析

Risk factors of early distant metastasis in patients with upper tract urothelial carcinoma after radical nephroureterectomy

目的探讨上尿路尿路上皮癌(UTUC)患者在根治术后早期(≤1年)出现远处转移的危险因素。方法回顾性分析2011年1月至2017年6月在四川大学华西医院接受了根治术的符合纳入条件的273例UTUC患者的临床资料,将术后早期(≤1年)出现远处转移的患者纳入转移组,将未出现远处转移的患者纳入非转移组;分析两组患者的临床资料,包括年龄、性别、TNM分期、肿瘤分级、手术时间、是否为乳头状肿瘤、是否存在淋巴血管侵犯(LVI)、是否吸烟,有无肾积水、高血压、糖尿病,术前是否长期(≥6个月)服用阿司匹林、二甲双胍,术后有无接受化疗等指标。结果术后早期出现远处转移的患者为50例(18.3%);其中肺部转移32例,肝转移15例,脑转移1例,骨转移2例。单因素分析显示:≥pT3期、高级别肿瘤、LVI、术前未长期服用阿司匹林、术后未辅助化疗是导致患者术后早期出现远处转移的危险因素。Logistic多因素分析显示:≥pT3期、LVI、术前未长期服用阿司匹林、术后未辅助化疗是导致患者术后早期出现远处转移的危险因素。结论≥pT3期、伴LVI的UTUC患者根治术后容易早期出现远处转移;而术前长期服用阿司匹林、术后及时给予化疗则可延缓远处转移的出现。

Objective To explore risk factors of early distant metastasis(≤1 year)in patients with upper tract urothelial carcinoma(UTUC)after radical nephroureterectomy(RNU).Methods The clinical data of 273 patients with UTUC who received RNU in West China Hospital of Sichuan University during Jan.2011 and Jun.2017 were retrospectively reviewed.Patients were divided into metastasis group and non-metastasis group.The patients’age,gender,TNM stage,tumor stage,time of operation,papillary neoplasm,lymphatic vascular invasion(LVI),smoking history,hydronephrosis,hypertension,diabetes,longterm preoperative use of aspirin and metformin,postoperative chemotherapy and other parameters were compared between the two groups.Results There were 50 patients(18.3%)who had distant metastasis within 1 year after RNU,including 32 cases with lung metastasis,15 cases with liver metastasis,1 case with brain metastasis and 2 cases with bone metastasis.Univariate analysis showed that≥pT3 stage,high-grade tumor,presence of LVI,no preoperative use of aspirin and no postoperative chemotherapy were risk factors of early distant metastasis after RNU.Multivariate logistic regression analysis indicated that≥pT3 stage,LVI,no preoperative use of aspirin and no postoperative chemotherapy were risk factors of early distant metastasis after RNU.Conclusion Presence of LVI and ≥pT3 stage are independent risk factors of early distant metastasis after RNU in UTUC patients,while long-term preoperative use of aspirin and postoperative chemotherapy can delay the emergence of early distant metastasis.