糖尿病及二甲双胍对上尿路肿瘤术后复发的影响  

Effect of diabetes mellitus and metformin on intravesical recurrence after radical nephroureterectomies in patients with upper urinary tract urothelial carcinoma

作　　者：刘豫[1] 薄志强[1] 张志宏[1] 

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300211

出　　处：《天津医科大学学报》2017年第1期53-55,58,共4页Journal of Tianjin Medical University

摘　　要：目的:探究糖尿病(DM)及二甲双胍的使用对上尿路肿瘤(UUT-UC)患者行根治性肾输尿管切除(RNU)术后膀胱内肿瘤复发的影响。方法:收集行RNU术且既往无膀胱肿瘤病史的301例UUT-UC患者临床资料。应用Kaplan-Meier法绘制生存曲线,Cox回归模型探讨RNU术后膀胱内肿瘤复发的临床影响因素。结果:纳入研究的患者中68例(22.6%)有DM,其中36例(12.0%)使用二甲双胍降糖药,随访期间有82例(27.2%)出现膀胱内肿瘤复发。非DM、DM未使用二甲双胍及DM使用二甲双胍患者膀胱内肿瘤复发的发生率分别为25.3%、53.1%、16.7%。Cox回归模型多因素分析显示,与非DM及DM使用二甲双胍相比,DM未使用二甲双胍患者无复发生存期(RFS)显著缩短(分别P=0.004;P=0.007),而DM使用二甲双胍较非DM患者的RFS差异无统计学意义(P=0.298)。结论:DM未使用二甲双胍是UUT-UC患者术后膀胱内肿瘤复发的危险因素,而使用二甲双胍可以降低甚至消除这种不利影响。Objective： To assess the effect of diabetes mellitus （DM） and metformin on intravesical recurrence of patients treated with radical＂ nephroureterectomies （RNU） for upper urinary tract urothelial carcinoma （UUT-UC）. Methods：The clinicopathological data of 301 patients with UUT-UC who received RNU and had no histories Of bladder neoplasm previously were retrospectively analyzed. Kaplan- Meier survival curves were applied to estimate survival time and Cox＇s regression model was conducted to explore the clinical impact factors for intravesical recurrence after RNU. Results： Of the 301 patients, a total of 68 （22.6%） patients had DM, of which 36 （12.0%） patients used metformin, and 82 （27.2%） patients experienced intravesieal recurrences. Intravesical recurrences were discovered in 25.3%, 53.1% and 16.7% of non-diabetic patients, DM without metformin, and DM with metformin, respectively. In Cox＇s regression model multivariate analysis, diabetic patients who did not use mefformin had a significantly shorter duration of recurrence-free survival （RFS）, compared with non-diabetic patients and diabetic patients who used metformin （P=O.O04, P=0.O07 respectively）, but diabetic patients who used metformin did not have a higher risk of RFS than non-diabetic patients （P=0.298）. Conclusion： DM patients with UUT-UC not taking metformin may be at an increased risk of intravesical recurrence after RNU, but the use of metformin can reduce or even eliminate the poor prognosis.

关 键 词：糖尿病 二甲双胍 尿路上皮癌 根治性肾输尿管切除术 膀胱肿瘤 肿瘤复发 

分 类 号：R737[医药卫生—肿瘤]