伴发结石的原发性上尿路尿路上皮癌患者延迟诊断7例分析

Analysis of 7 cases of delayed diagnosis of primary upper tract urothelial carcinoma with calculi

目的分析伴结石的原发性上尿路尿路上皮癌患者(UTUC)的临床资料,以降低此类患者的误诊率。方法回顾性分析在2018年9月-2022年4月在北京医院确诊的UTUC合并同侧上尿路结石的7例患者的临床资料、分析其就诊到确诊的时间、影像学资料、尿脱落细胞学、手术方式、病理分期、随诊情况等。结果7例患者男女比为3∶4,平均年龄66.4(55~72)岁,首诊影像检查仅做出结石诊断,均未提示可疑肿瘤病变(含1例缺失资料),就诊到确诊中位时间12(5~36)个月,其中通过增强CT临床诊断2例(2/4),磁共振临床诊断3例(3/4),尿病理阳性临床诊断2例(2/7)。7例患者均接受了手术治疗,其中输尿管癌4例、肾盂癌3例,术后病理显示高级别UTUC比例85.71%(6/7)。术后分期T1N0M04例,T3N0M02例,T4N2M01例。术后辅助化疗2例。术后中位随访时间12(6~41)个月,1例患者随访9个月时发现全身多处转移,其余患者未见复发和转移。结论对于影像学上充盈缺损不明显的UTUC,当合并有同侧上尿路结石的情况下须警惕对UTUC的漏诊,避免影响患者的治疗和预后。

Objective To reduce the misdiagnosis rate by analyzing the clinical data of patients with primary upper tract urothelial carcinoma(UTUC)complicated with calculi.Methods Clinical data of 7 UTUC with calculi patients treated during Sep.2018 and Apr.2022 were retrospectively analyzed,including general data,time from visit to diagnosis,imaging data,urine exudation cytological results,surgical methods,pathological stages and follow-up data.Results The ratio of male to female was 3∶4,and the mean age was 66.4(55-72)years.The initiate imaging examination results only showed calculi,but did not indicate suspicious tumor(including 1 case with missing data).The median time from the first visit to diagnosis was 12 months(5-36 months).Of all 7 cases,2(2/4)were clinically diagnosed by enhanced CT,3(3/4)by MRI,and 2(2/7)by positive urine exudation cytology.All patients received surgical treatment.Postoperative pathology showed 85.71%(6/7)were high-grade UTUC.Postoperative staging was T1N0M0 in 4 cases,T3N0M0 in 2 cases,and T4N2M0 in 1 case.Adjuvant chemotherapy was conducted in 2 cases.During the median follow-up of 12 months(6-41),1 case developed multiple systemic metastases in month 9,while the other cases had no recurrence or metastasis.Conclusion For UTUC patients without obvious filling defect on imaging,especially when ipsilateral calculi were complicated,misdiagnosis should be alerted for timely treatment and better prognosis.