高风险上尿路尿路上皮癌辅助化疗疗效分析及预后相关因素研究  

The prognostic factors and analysis of adjuvant chemotherapy for high risk upper tract urothelial carcinoma

作　　者：杜智勇[1] 秦川[1] 申忠华[1] 陈斐然[1] 唐刚[1] 田大伟[1] 胡海龙[1] 吴长利[1] Du Zhiyong Qin Chuan Shen Zhonghua Chen Feiran Tang Gang Tian Dawei Hu Hailong Wu Changli.(Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin Key Basic Laboratory of Urology, Tianjin 300211, China)

机构地区：[1]天津医科大学第二医院泌尿外科天津市泌尿外科研究所天津市泌尿外科基础医学重点实验室,300211

出　　处：《中华泌尿外科杂志》2016年第11期808-812,共5页Chinese Journal of Urology

基　　金：天津市应用基础与前沿技术研究计划（14JCYBJC26300）

摘　　要：目的 探讨高风险[T3/T4（No/N＋）期]上尿路尿路上皮癌辅助化疗疗效及预后的相关因素.方法 回顾性分析2011年9月至2016年2月收治的92例上尿路尿路上皮癌患者的临床和随访资料,男54例,女38例.年龄44～94岁,平均67岁.肿瘤直径1～8 cm,平均3.6 cm.所有患者均行上尿路尿路上皮癌根治性手术.病理学分期均为T3/T4（No/N＋）期.47例（51％）接受辅助化疗治疗.根据是否化疗将患者分为化疗组和非化疗组.采用性别、年龄、东部肿瘤协作组（EasternCooperative Oncology Group,ECOG）评分、肿瘤大小、肿瘤数量、肿瘤分期及分级作为分层指标,比较两组各项指标的差异.采用Cox比例风险回归模型分析上尿路尿路上皮癌根治性手术后是否联合辅助化疗及不同临床病理因素对患者总生存期及肿瘤特异性生存期的影响.结果 本组92例患者随访4～ 52个月,中位随访时间为24.4个月.21例（22.8％）死于肿瘤,5例（5.4％）死于其他原因.是否行辅助化疗对患者总生存期（P＞0.05）和特异性生存期（P＞0.05）无影响,肿瘤分期（P=0.018,P=0.010）和ECOG评分（P =0.011,P=0.034）是患者总生存期和肿瘤特异性生存期的独立影响因素.结论 辅助化疗对于T3/T4（No/N＋）期上尿路尿路上皮癌患者的总生存期和肿瘤特异性生存期无影响,肿瘤分期和ECOG评分是肿瘤特异性生存期的独立预后因素.Objective To evaluate the prognostic factors and the effect of adjuvant chemotherapy for T3/T4 （N0/N＋） upper tract urothelial carcinoma （UTUC）.Methods 92 cases of UTUC and clinical follow-up data from September 2011 to February 2016 were analyzed retrospectively.All patients underwent radical surgery and analyzed pathological examination for all surgical specimens.There was 92 cases of T3/T4（No/N＋）UTUC,54 males and female;age were from 44 to 94 years,mean age was 67 years;tumor size were 1-8cm,mean size was 3.6cm.47 cases （51％）received adjuvant chemotherapy.These patients were divided into 2 groups which depend whether patents received adjuvant chemotherapy or not.Cohorts were stratified by gender,age,performance status,tumor number,size,grade and stage.The chi-square test was used to examine the relationship among the various cohorts and the receipt of adjuvant chemotherapy.Cox proportional hazard modeling and Kaplan-Meier analysis were used to determine overall and cancer specific survival in the cohort.Results The median follow-up time was 24（range：4-52）months,and during followup,21 cases（22.8％）were died for cancer,5 cases（5.4％） were died for other reasons.There was no significant difference in overall or cancer specific survival between patients who did and did not receive adjuvant chemotherapy （P ＞ 0.05）.However performance state （P =0.011,P =0.034） and tumor stage （P =0.018,P =0.010） were significant predictors of overall and cancer specific survival.Conclusions This finding suggested that adjuvant chemotherapy confered minimal impact on overall survival or cancer specific survival in this group.However,performance statas and tumor stage were significant predictors of overall and cancer specific survival.

关 键 词：上尿路尿路上皮癌 辅助化疗 生存分析 预后 

分 类 号：R737.1[医药卫生—肿瘤]