原发性输尿管非尿路上皮癌的临床诊治分析

Clinical diagnosis and treatment of primary non-urothelial carcinoma of ureter

目的探讨原发性输尿管非尿路上皮癌的临床病理特点、治疗和预后。方法回顾性分析2018年1月-2020年10月就诊于河北省人民医院的5例输尿管非尿路上皮癌患者的临床资料及术后随访情况。其中男性2例,女性3例,平均年龄74(64-83)岁,因腰痛就诊3例,血尿就诊3例。合并高血压3例,肾积水3例,泌尿系感染2例,输尿管结石、右肾萎缩、糖尿病和前列腺癌各1例。1例行放疗,3例行根治性肾输尿管切除术+膀胱袖口状切除术+术后化疗,1例于外院行根治性肾输尿管切除术+膀胱袖口状切除术+免疫治疗。结果病理诊断输尿管小细胞癌2例(合并肾盂小细胞癌1例),鳞癌1例,腺癌(合并肾盂腺癌)1例,淋巴上皮样癌1例。中位随访时间8个月。1例因肿瘤进展于术后4个月死亡,4例生存,其中无病生存3例,1例于确诊后3个月出现腹膜后转移,6个月时出现纵隔转移。结论原发性输尿管非尿路上皮癌发病率低,确诊有赖于术后病理检查,免疫组化有利于各亚型鉴别。治疗首选根治性肾输尿管切除术+膀胱袖口状切除术,预后总体较差,易复发及转移,放化疗及免疫治疗或可改善患者的预后。

Objective To explore the clinicopathological features,treatment and prognosis of primary non-urothelial carcinoma of the ureter.Methods Clinical and follow-up data of 5 patients treated at our hospital during Jan.2018 and Oct.2020 were retrospectively analyzed,including 2 males and 3 females.The patients average age was 74(64-83)years.Three cases went to hospital due to low back pain and 3 due to hematuria.Three cases had hypertension,3 had hydronephrosis,2 had urinary tract infection,1 had ureteral calculi,1 had right renal atrophy,1 had diabetes and 1 had prostate cancer.Radiotherapy was performed in 1 case,radical renal ureterectomy+cystectomy+postoperative chemotherapy in 3 cases,and radical renal ureterectomy+cystectomy+immunotherapy in 1 case.Results There were 2 cases of ureteral small cell carcinoma(1 case complicated with renal pelvis small cell carcinoma),1 case with squamous cell carcinoma,1 case with adenocarcinoma(complicated with renal pelvis adenocarcinoma)and 1 case with lymphoepithelial carcinoma.During the median follow-up of 8 months,1 patient died 4 months after surgery due to tumor progression,and 4 patients survived,3 of whom were disease-free.Retroperi-toneal metastasis was observed in 1 case after 3 months,and mediastinal metastasis occurred after 6 months.Conclusion Primary non-urothelial carcinoma of the ureter is rare,which can be diagnosed with postoperative pathology.Immunohistochemistry is helpful to identify the subtypes.The preferred treatment is radical ureterectomy+cuff bladder resection.However,the prognosis is poor,and recurrence and metastasis frequently occur.Radiotherapy,chemotherapy and immunotherapy may improve the prognosis.