年轻上尿路尿路上皮癌患者的临床病理和预后特征  

Clinicopathological features and prognosis of young patients with upper tract urothelial carcinoma

作　　者：曹振朋 关豹 方冬[1] 熊耕砚 何世明[1] 李学松[1] 周利群[1] 

机构地区：[1]北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京100034

出　　处：《现代泌尿外科杂志》2017年第9期661-665,共5页Journal of Modern Urology

基　　金：北京市自然科学基金(No.7152146)

摘　　要：目的探讨年轻(<55岁)上尿路尿路上皮癌(UTUC)患者的临床病理特点,为UTUC的个性化治疗提供更多的临床依据。方法回顾性分析1999年到2011年期间经术后病理确诊并且随访资料完整的UTUC患者687例,根据年龄是否小于55岁将其分为年轻组(<55岁)和年长组(≥55岁),对比两组患者的临床病理资料;结果年轻上尿路上皮癌男性患者较多(P=0.023),多具有吸烟史(P=0.003),较少伴肿瘤坏死(P=0.014),合并中度或重度肾功能不全(肾小球率过滤估算值eGFR<60mL/min/1.73m2)的比例较低(P<0.001),VIM基因启动子甲基化率较低(P=0.035);肾积水与年轻UTUC的病理高级别[(G1+G2)vs.G3]相关(P=0.002);年龄<55岁的男性UTUC患者术后生存情况比≥55岁的男性患者好;吸烟(P=0.045)、肿瘤的多灶性(P=0.049)和最大径>5cm(P=0.007)是<55岁患者的术后生存的独立危险因素。结论年龄<55岁的年轻UTUC患者在性别、生活习惯、肾功能、基因启动子甲基化和病理特点等方面存在较大差异,临床医生可参考吸烟史、肿瘤的多灶性和最大径来评估其预后。Objective To investigate the clinicopathological features of young patients （age（5g years） with upper tract urothelial carcinoma （UTUC）. Methods A retrospective study of 687 UTUC patients was conducted. The patients were divid- ed into young group （age〈55 years） and old group （age^55 years）. The clinicopathological features and survival rate of the two groups were analyzed. Results Compared with the old group,the young group had more male （P=0. 023） ,higher rate of smoking history （P= 0. 003）, less presence of tumor necrosis （P = 0. 014）, lower rate of VIM promoter methylation （P = 0.035）, lower incidence of medium or severe renal insufficiency r estimate glomerular filtration rate eGFR（60 mL/（min 1.73 mZ）]（P（0.001）,higher grade of hydronephrosis （GI＋G2 vs. G3） （P=0.002）,andlonger survival （P=0.017）.Smoking history （P=0. 045） ,multifocality （P=0. 049） and tumor diameter〉5 cm （P=0. 007） were the independent risk factors of sur- vival for young UTUC patients. Conclusion Young UTUC patients exhibited different clinicopathological features in gender, living habits, kidney function and VIM promoter methylation from old patients. Smoking history, tumor multifocality and tumor diameter could help clinicians to evaluate the outcomes of UTUC.

关 键 词：年龄 上尿路尿路上皮癌 预后 吸烟 甲基化 

分 类 号：R737.1[医药卫生—肿瘤]