结直肠癌发生恶性肾盂积水的临床特征及预后

Clinical characteristics and outcome of malignant hydronephrosis associated with colorectal carcinoma

目的探讨局部晚期或转移性结直肠癌患者发生肾盂积水的临床特征及预后。方法回顾性收集2017年6月至2020年3月就诊于中国医学科学院肿瘤医院深圳医院311例局部晚期或转移性结直肠癌患者的临床资料,CT示恶性肾盂积水者39例。生存期分析采用Kaplan-Meier法,两组间生存率的比较采用Log rank检验,单因素及多因素分析采用Cox比例风险回归模型。结果恶性肾盂积水的发生率为12.5%(39/311),男26例,女13例,年龄23~74岁,中位年龄43岁。全组39例肾盂积水患者中,单侧肾盂积水29例,双侧10例。初诊时即出现肾盂积水11例,复发或肿瘤进展后出现肾盂积水28例,发生肾盂积水的时间为4~62个月,中位时间为17个月。接受一线化疗患者,初诊伴肾盂积水和一线化疗时无肾盂积水患者的疾病控制率(分别为77.8%和84.6%)及中位无进展生存时间(分别为6和7个月)差异均无统计学意义(均P>0.05)。发生恶性肾盂积水后患者中位生存时间为26个月。多因素分析显示,脉管瘤栓为影响患者发生肾盂积水后总生存的独立影响因素(P<0.05)。结论恶性肾盂积水的发生不影响结直肠癌患者一线化疗疗效及一线化疗后无进展生存时间,脉管瘤栓为影响结直肠癌患者出现恶性肾盂积水后总生存的独立影响因素。

Objective To explore the clinical characteristics and outcome of hydronephrosis associated with advanced or metastatic colorectal carcinoma.Methods Clinical data of 311 patients with locally advanced or metastatic colorectal carcinoma between June 2017 and March 2020 in National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital&Shenzhen Hospital were retrospectively collected.Thirty-nine patients with hydronephrosis diagnosed by CT scan were analyzed.Kaplan-Meier method was used for survival analysis,Log rank method was used for comparison of survival between the two groups with or without hydronephrosis,and univariate and multivariate analyses was performed by Cox proportional risk regression model.Results The incidence rate of malignant hydronephrosis associated with metastatic colorectal carcinoma was 12.5%(39/311),26 were male,and 13 were female.The median age was 43 years(23-74 years).Among the 39 patients,29 had unilateral hydronephrosis and 10 had bilateral hydronephrosis.Eleven patients with hydronephrosis at the initiate diagnosis,28 patients with hydronephrosis at relapse or advanced course,and the median time to hydronephrosis was 17 months(4-62 months).The disease control rate(DCR,77.8%and 84.6%,respectively)and progression free survival(PFS were 6 and 7 months)were not significantly different between patients with hydronephrosis and without hydronephrosis received the first-line chemotherapy(P>0.05).The median overall survival(OS)after presence of hydronephrosis was 26 months(95%CI:8.3,43.7).Multivariate analyses showed that the blood vessel invasion(LVSI)was an independent risk factor for OS(P<0.05).Conclusions Malignant hydronephrosis had no effect on the efficacy of the first-line chemotherapy and PFS of patients with colorectal carcinoma received the first-line chemotherapy.LVSI was the independent prognostic factor for OS of patients with malignant hydronephrosis.