根治术联合辅助化疗对高风险上尿路尿路上皮癌患者生存预后的影响  

Oncologic outcomes of high-risk upper tract urothelial carcinoma patients undergoing radical nephroureterectomy combined with adjuvant chemotherapy

作　　者：冯炳富 罗勇[1] 魏德超 韩毅力[1] 李明川[1] 赵佳晖[1] 林云华[1] 侯铸[1] 姜永光[1] Feng Bingfu;Luo Yong;Wei Dechao;Han Yili;Li Mingchuan;Zhao Jiahui;Lin Yunhua;Hou Zhu;Jiang Yongguang(Department of Urology, Affiliated Beijing Anzhen Hospital of Capital Medical University, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院泌尿外科,北京100029

出　　处：《中华医学杂志》2019年第2期115-119,共5页National Medical Journal of China

基　　金：国家自然科学基金 (30700968);北京市卫生系统高层次卫生技术人才学科骨干培养项目 (2015-3-054).

摘　　要：目的探讨高风险上尿路尿路上皮癌(UTUC)根治性肾输尿管切除术(RNU)后辅助化疗(ACT)改善患者生存预后的临床意义。方法采用前瞻性随机对照研究(RCT)方法,将134例高风险UTUC患者按区组随机化原则,分为单纯RUN治疗组和RUN+ACT治疗组,观察ACT治疗反应,并对比总结两组患者的预后资料,评价ACT在UTUC患者中的应用价值。结果RUN组入组61例患者,中位随访时间24(6~36)个月,RUN+ACT组入组73例患者,中位随访时间18(6~36)个月。所有ACT患者均未观察到难以控制的世界卫生组织(WHO)4级化疗毒性反应。尽管ACT有改善高风险UTUC患者RUN术后总体生存率(OS)及肿瘤特异生存率(CSS)的趋势,但在本研究中并未达到统计学差异程度。进一步分析发现,ACT可以改善淋巴结阳性UTUC患者的预后:中位OS延长12.1个月(30.1与18.0个月)、3年OS提高18.4%(49.1%与30.7%,P=0.083),中位CSS延长10.6个月(29.2与18.6个月)、3年CSS提高17.7%(55.9%与38.2%,P=0.047);此外,ACT也可以改善T3/T4期UTUC患者的预后:中位OS延长12.6个月(25.2与12.6个月)、3年OS提高14.1%(41.4%与27.3%,P=0.038),中位CSS延长12.4个月(31.3与18.9个月)、3年CSS提高18.5%(49.2%与30.7%,P=0.044)。结论ACT是一项安全有效的治疗措施,对于淋巴结阳性或高分期(T3/T4)的UTUC患者,ACT具有显著改善预后的临床价值。Objective To assess the oncologic outcomes of radical nephroureterectomy (RUN) combined with adjuvant chemotherapy (ACT) in patients with high risk upper tract urothelial carcinoma (UTUC). Methods One-hundred-thirty-four individuals with high-risk UTUC who underwent RUN with or without ACT were evaluated. Cox proportional hazard model and Kaplan-Meier analysis were used to determine overall and cancer specific survival in the cohort. Results The median follow-up duration was 24 months (range: 6-36) in the RUN group (n=61) and 18 months (range: 6-36) in the RUN+ACT group (n=73). Median time of overall survival (OS) and cancer specific survival (CSS) showed much better in RUN+ACT group than in RUN group, but the differences were not reached the significant standard. The further analysis in lymph node positive cohort displayed that median times of oncologic events were prolonged in the RUN+ACT group compared with the RUN group: OS (30.1 mon vs 18.0 mon, P=0.083) and CSS (29.2 mon vs 18.6 mon, P=0.047). Additionally in T3/T4 cohort, the significant growth in the median times of OS (25.2 mon vs 12.6 mon, P=0.038) and CSS (31.3 mon vs 18.9 mon, P=0.044) were observed in combination treatment group. Conclusion ACT could play the important synergistic role in improving the OS and CSS of RUN treated UTUC patients with lymph node-positive or stage of T3/T4.

关 键 词：肾输尿管切除 上尿路 尿路上皮癌 辅助化疗 

分 类 号：R737.1[医药卫生—肿瘤]