淋巴血管侵犯对上尿路尿路上皮癌根治切除联合化疗预后的影响

Effect of lymphovascular invasion on the prognosis of radical resection combined with chemotherapy for upper tract urothelial carcinoma

目的分析上尿路尿路上皮癌(UTUC)根治性肾输尿管全长切除术(RNU)术后病理显示淋巴血管侵犯(LVI)阳性的患者行吉西他滨联合顺铂方案(GC)化疗预后的影响。方法回顾性分析2013年3月—2019年3月首都医科大学附属北京友谊医院收治的95例UTUC患者的临床资料,其中男性50例,女性45例;平均年龄为63岁,范围为36~81岁。根据LVI情况将其分为LVI阳性组(n=25)和LVI阴性组(n=70)。采用χ^2检验对两组患者的临床病理参数进行分析,采用Kaplan-Meier法绘制两组患者的总体生存(OS)时间和无复发生存(RFS)时间的生存曲线,采用Log-Rank检验比较两组之间的差异。采用单因素和多因素Cox回归模型评估OS和RFS的相关危险因素。结果所有患者平均随访时间为36个月,范围为2~82个月。95例UTUC患者中,共死亡20例(21.1%),复发36例(37.9%)。LVI阳性组和LVI阴性组患者在T分期(P=0.046)、淋巴结转移(P=0.032)、肿瘤位置(P=0.019)方面,差异均具有统计学意义。单因素分析结果显示,肾积水(P=0.026)、淋巴结转移(P=0.001)、LVI(P=0.001)、化疗周期(P=0.045)与OS相关;肾积水(P=0.031)、肿瘤T分期(P=0.013)、淋巴结转移(P=0.004)、LVI(P=0.001)与RFS明显相关。多因素分析结果显示,肾积水(P=0.016)、淋巴结转移(P=0.016)、LVI(P=0.003)与OS明显相关。淋巴结转移(P=0.018)、LVI(P=0.003)和RFS明显相关。由此可见,LVI是OS、RFS的独立危险因素。UTUC患者术后病理LVI阳性组患者行GC方案化疗的OS[LVI阳性组患者平均OS为(40.7±6.5)个月,LVI阴性组患者平均OS为(68.5±3.2)个月,χ^2=15.750,P<0.001]、RFS[LVI阳性组患者中位RFS为(31.0±5.7)个月,LVI阴性组患者中位RFS为(58.0±8.8)个月,χ^2=10.986,P=0.001]均差于LVI阴性组患者,差异均具有统计学意义。结论LVI阳性更容易出现在高T分期、淋巴结转移、单发肾盂的患者中,为UTUC患者危险分层提供一定依据。LVI阳性的UTUC患者根治切除联合辅助化疗后在OS和RFS上的受益明显差于LVI阴性患者。

Objective To investigate the prognostic significance of the lymphovascular invasion(LVI)in patients with upper tract urothelial carcinoma(UTUC)after radical nephoureterectomy(RNU)and Gemcitabine and Cisplatin combination Chemotherapy(GC).Methods The clinical data of 95 patients with UTUC admitted to Beijing Friendship Hospital,Capital Medical University from March 2013 to March 2019 were analyzed retrospectively.There were 50 males and 45 females;the average age was 63 years,ranged from 36 to 81 years.According to the situation of LVI,they were divided into LVI positive group(n=25)and LVI negative group(n=70).Chi-square test was used to analyze the clinicopathological parameters of the two groups of patients.Kaplan-Meier method was used to draw the survival curves of the overall survival(OS)time and recurrence-free survival(RFS)time of the two groups of patients.The difference between the two groups was used Log-Rank test.The risk factors related to OS and RFS were evaluated using univariate and multivariate Cox regression models.Results All patients were followed up for 2-82 months,with an average follow-up time of 36 months.Among them,20(21.1%)died and 36(37.9%)relapsed.There were significant differences in T stage(P=0.046),lymph node metastasis(P=0.032),and tumor location(P=0.019)between LVI negative group and LVI negative group.Univariate analysis showed that hydronephrosis(P=0.026),lymph node metastasis(P=0.001),LVI(P=0.001),chemotherapy cycle(P=0.045)were correlated with OS;hydronephrosis(P=0.031),tumor T stage(P=0.013),lymph node metastasis(P=0.004),LVI(P=0.001)were significantly correlated with RFS.Multivariate analysis showed that hydronephrosis(P=0.016),lymph node metastasis(P=0.016),and LVI(P=0.003)were significantly correlated with OS.Lymph node metastasis(P=0.018),LVI(P=0.003)were significantly correlated with RFS.In conclusion,LVI was an independent risk factor for OS and RFS.The OS[(40.7±6.5)months for LVI positive group,(68.5±3.2)months for LVI negative group,χ^2=15.750,P<0.001]and RFS[(31.0±5.7)months for LVI positive group,(58.0±8.8)months for LVI negative group,χ^2=10.986,P=0.001]of patients with LVI positive group were worse than those with LVI negative group,the differences were statistically significant.Conclusions LVI is more likely to be possitive in patients with high T stage,lymph node metastasis and single renal pelvis cancer,which provides a basis for risk stratification of patients with UTUC.After radical resection and adjuvant chemotherapy,the benefit of OS and RFS in patients with positive LVI was significantly worse than that in patients with negative LVI.