膀胱根治性切除术患者输尿管切缘阳性的危险因素

Risk factors of positive ureteral margin after radical cystectomy

目的探讨膀胱癌患者膀胱根治性切除术(RC)后输尿管切缘阳性的危险因素。方法回顾性分析2018年1月-2021年6月山东大学齐鲁医院泌尿外科231例行RC的膀胱癌患者的临床信息。根据术中冰冻切片分析和(或)术后常规病理分析结果将患者分为输尿管切缘阳性组及输尿管切缘阴性组,单因素分析及多因素二项分类logistic回归分析输尿管切缘阳性的危险因素,构建预测模型,基于该模型描绘Nomogram列线图,并对模型进行受试者工作特征曲线(ROC)检验。结果本研究中231例行RC患者中,术中冰冻切片分析和(或)术后病理分析输尿管远端切缘阳性患者24例(10.4%),切缘阴性患者207例(89.6%),单因素分析显示,两组患者在是否存在术前肾积水(P<0.01)、原位癌(P<0.001)、三角区肿瘤(P<0.001)的差异有统计学意义。多因素二项分类logistic回归分析结果显示,存在肾积水(OR=16.37,95%CI 5.00~53.58,P<0.01)、原位癌(OR=13.95,95%CI 3.27~59.53,P<0.01)、三角区肿瘤(OR=3.86,95%CI 1.32-11.21,P=0.013)与输尿管切缘阳性明显相关。根据分析结果构建预测模型,ROC曲线检测显示该模型具有良好的敏感性及特异性(AUC=0.866,P<0.05)。结论术前肾积水、原位癌、三角区肿瘤是膀胱癌根治性切除术患者输尿管切缘阳性的危险因素。

Objective To investigate the risk factors of positive ureteral margin after radical cystectomy(RC)in patients with bladder cancer.Methods Clinical data of 231 patients with bladder cancer treated during Jan.2018 and Jun.2021 were retrospectively analyzed.According to the results of intraoperative frozen section analysis and/or postoperativepathology,the patients were divided into positive and negative ureteral margin groups.Risk factors were identified with univariate and multivariate binary logistic regression analyses to construct a prediction model,based on which a nomogram was configured,and the receiver operating characteristic(ROC)curve was drawn to test the model.Results Among the 231 patients,24(10.4%)had positive ureteral margins and 207(89.6%)had negative ureteral margins.Univariate analysis showed significant differences in preoperative hydronephrosis(P<0.01),carcinoma in situ(P<0.001)and trigone tumor(P<0.001)between the two groups.Multivariate analysis showed that hydronephrosis(OR=16.37,95%CI:5.00-53.58),carcinoma in situ(OR=13.95,95%CI:3.27-59.53)and trigone tumor(OR=3.86,95%CI:1.32-11.21)were significantly correlated with the positive ureteral margin.The ROC curve of the prediction model showed good sensitivity and specificity(AUC=0.866,P<0.05).Conclusion Preoperative hydronephrosis,carcinoma in situ and trigone tumor are independent risk factors of positive ureteral margin in patients after radical cystectomy.