上尿路移行细胞癌术后膀胱复发的危险因素分析  

Risk factors of postoperative intravesical recurrence for upper tract urothelial carcinoma

作　　者：张东正[1] 高靖达 王鑫朋 张瑞珊[1] 王锐[1] 刘春雨[1] 刘利维[1] 

机构地区：[1]天津医科大学第二医院泌尿外科,天津300211

出　　处：《临床泌尿外科杂志》2016年第5期422-424,427,共4页Journal of Clinical Urology

摘　　要：目的：探讨上尿路移行细胞癌行根治性肾输尿管切除术后出现膀胱内复发的危险因素。方法：回顾性分析我院2005年1月～2012年12月收治的353例行根治性肾输尿管切除术的上尿路移行细胞癌患者病例资料,通过单因素和多因素分析术后出现膀胱复发的相关危险因素。结果：353例患者术后膀胱复发72例（20.4%）,平均随访时间39个月,平均复发时间21个月。多因素COX回归分析显示,糖尿病（HR=1.724;95%CI：1.009～2.948;P=0.046）、肿瘤多发（HR=1.852;95%CI：1.043～3.288;P=0.035）和尿脱落细胞阳性（HR=2.075;95%CI：1.225-3.515;P=0.007）是术后膀胱内复发的独立危险因素。结论：糖尿病、肿瘤多发和尿脱落细胞学阳性是上尿路移行细胞癌行根治性肾输尿管切除术后膀胱内复发的独立危险因素,术后应密切随访、积极治疗。Objective：To investigate the risk factors of intravesical recurrence after radical nephroureterectomy（RNU）for upper tract urothelial carcinoma.Method：The clinical and pathological data of 353 patients with upper tract urothelial carcinoma who underwent nephroureterectomy between January 2005 and December 2012 were retrospectively analyzed.Univariate and multivariate analyses were used to evaluate the risk factors associated with the postoperative intravesical recurrence.Result：A total of 72patients（20.4%）developed intravesical recurrence after a median follow-up of 39 months and the median interval of intravesical recurrence was 21 months.In multivariate analysis,diabetes（HR=1.724;95%CI：1.009-2.948;P=0.046）,tumor multifocality（HR=1.852;95%CI：1.043-3.288;P=0.035）and positive urine cytology（HR=2.075;95% CI：1.225-3.515;P=0.007）were independent risk factors of postoperative intravesical recurrence.Conclusion：Diabetes,tumor multifocality and positive urine cytology are independent risk factors of postoperative intravesical recurrence of upper tract urothelial carcinoma.Close follow-up and active treatment are important for patients with high risk factors.

关 键 词：上尿路移行细胞癌 膀胱癌 复发 危险因素 

分 类 号：R737[医药卫生—肿瘤]