不同分期上尿路尿路上皮癌患者预后分析

Prognostic analysis of patients with urothelial carcinoma of upper urinary tract in different stages

目的:探究不同分期的肾盂癌及输尿管癌患者预后是否存在差异性。方法:回顾性分析2011—2018年我院诊断为上尿路尿路上皮癌(UTUC)的199例患者的临床资料,按肿瘤发生部位分为肾盂癌组及输尿管癌组。Cox比例危险模式分析患者的无复发生存率(RFS)、肿瘤特异性生存率(CSS)和总体生存率(OS)与预后相关的病理特点。Kaplan-Meier生存回归曲线分析上述特点对预后是否存在统计学意义。结果:在Cox分析中肿瘤的病理分级分期可以作为肿瘤复发及死亡的预测因素。原发肿瘤部位在RFS、CSS或OS上差异均无统计学意义(P=0.074、0.69、0.75)。Kaplan-Meier生存回归曲线分析中肿瘤位置不会对预后产生影响(RFS:P=0.148,CSS:P=0.332),而输尿管镜检降低输尿管癌CSS(P=0.021)。将肾盂癌组及输尿管癌组按照T_(a)+T_(is)+T_(1)、T_(2)及T_(3)+T_(4)期分成3个亚组进行生存回归分析,各个亚组中肾盂癌与输尿管癌不存在预后差异性。结论:术前输尿管镜活检更易造成输尿管癌患者肿瘤特异性死亡,但UTUC不存在肿瘤原发位置的预后性差异。因此不应将UTUC的肿瘤部位作为临床决策的考虑因素,而对疑似输尿管癌患者是否行输尿管镜活检需谨慎决定。

Objective:To explore whether there was difference in the prognosis of patients with renal pelvic cancer and ureteral cancer in different stages.Methods:A retrospective analysis of the clinical data of 199 patients diagnosed with upper urinary urothelium in the Department of Urology,First Affiliated Hospital of Chongqing Medical University from 2011 to 2018 was done.These patients were divided into renal pelvic cancer group and ureteral cancer group according to the tumor location.The Cox proportional hazard model analyzed the pathological characteristics of patients with recurrence-free survival(RFS),cancer-specific survival(CSS)and overall survival(OS).Kaplan-Meier survival regression curve was used to analyse whether the above characteristics were statistically significant for the prognosis of patients.Results:In the Cox analysis,the pathological grading and staging of tumors could be used as predictors of tumor recurrence and death.There was no statistically significant difference in the location of the primary tumor in RFS,CSS or OS(P=0.074,0.69,0.75,respectively).The tumor location in Kaplan-Meier survival regression curve analysis did not affect the prognosis of patients(RFS:P=0.148,CSS:P=0.332),but ureteroscopy biopsy reduced the CSS of ureteral cancer(P=0.021).According to T_(a)+T_(is)+T_(1),T_(2) and T_(3)+T_(4)stages,upper urinary tract urothelial carcinoma was divided into three subgroups for survival analysis.There was no difference in prognosis between renal pelvic cancer and ureteral cancer in each subgroup.Conclusion:Preoperative ureteroscopy biopsy is more likely to cancer-specific death in patients inpatients with ureteral cancer,but there is no prognostic difference in the location of the tumor in the upper urinary tract urothelial tumor.Therefore,the location of upper urinary tract urothelial tumors should not be considered as a clinical decision-making factor,and whether patients with suspected ureteral cancer should undergo ureteroscopy biopsy should be carefully determined.