探究减瘤手术对合并远处转移的上尿路尿路上皮癌患者预后的影响

Exploring the effect of tumor reduction surgery on the prognosis of upper tract urothelial carcinoma patients with metastasis

目的探究减瘤手术对合并远处转移的上尿路尿路上皮癌患者预后的影响。方法筛选2010年1月至2015年12月SEER数据库中已经发生远处转移的上尿路尿路上皮癌患者的临床数据,根据是否行减瘤手术分为减瘤手术组和未做减瘤手术组,比较组间基线差异。通过单因素和多因素Cox比例风险回归模型分析与已经发生远处转移的上尿路尿路上皮癌患者生存有关的预后影响因素。通过Kaplan-Meier法绘制生存曲线分析各组的生存情况。结果本研究共纳入患者238例,减瘤手术者157例,未做减瘤手术者81例,总体基线较为平稳。单因素和多因素Cox回归分析结果显示:减瘤手术、化学药物治疗(以下简称化疗)、肝转移是总生存期(overall survival,OS)的独立风险因素;减瘤手术和化疗是癌症特异性生存期(cancer special survival,CSS)的独立风险因素。Kaplan-Meier曲线显示:年龄、减瘤手术、化疗、肝转移与OS密切相关;减瘤手术、化疗、肝转移与CSS密切相关。结论对于已经发生远处转移的上尿路尿路上皮癌患者,减瘤手术可明显改善患者预后,减瘤手术、化疗、肝转移是总生存结局的独立影响因素,减瘤手术和化疗是疾病相关生存结局的独立影响因素。

Objective To explore the effect of tumor reduction surgery on the prognosis of upper urinary tract urothelial cancer patients with distant metastasis.Methods The clinical data of upper urinary tract urothelial cancer patients with distant metastasis were screened in SEER database from January 2010 to December 2015.According to whether tumor reduction surgery was performed or not,the patients were divided into two groups:tumor reduction operation group and non-tumor reduction operation group.Univariate and multivariate Cox proportional hazard regression models were used to analyze the prognostic factors related to the survival of upper urinary tract urothelial cancer patients with distant metastasis.The survival curve was drawn by Kaplan-Meier method to analyze the survival condition of each group.Results A total of 238 patients were included in this study,157 patients underwent tumor reduction surgery and 81 patients did not.The overall baseline was relatively stable.Cox univariate analysis showed that tumor reduction surgery,chemotherapy,liver metastasis were independent risk factors for overall survival(OS),while tumor reduction surgery and chemotherapy were independent risk factors for cancer special survival(CSS).Kaplan-Meier curve showed that tumor reduction surgery,chemotherapy and liver metastasis were closely related to OS,while tumor reduction surgery,chemotherapy and liver metastasis were closely related to CSS.Conclusion For patients with upper urinary tract urothelial carcinoma with distant metastasis,tumor reduction surgery can significantly improve the prognosis.Tumor reduction surgery,chemotherapy,and liver metastasis are independent factors affecting the overall survival outcome.Tumor reduction surgery and chemotherapy are independent factors affecting the cancer special survival outcome.