肿瘤大体形态与上尿路尿路上皮癌患者预后的相关性分析  

Impact of tumor architecture on prognosis of patients with upper tract urothelial carcinoma

作　　者：袁易初 张楠[1] 黄吉炜[2] 张进[2] 陈勇辉[2] 黄翼然 杜传军[1] 陈继民[1] 薛蔚[2] Yuan Yichu;Zhang Nan;Huang Jiwei;Zhang Jin;Chen Yonghui;Huang Yiran;Du Chuanjun;Chen Jimin;Xue Wei(Department of Urology,The Second Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310009,China;Department of Urology,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]浙江大学医学院附属第二医院泌尿外科,浙江310009 [2]上海交通大学医学院附属仁济医院泌尿科,上海200127

出　　处：《中华泌尿外科杂志》2020年第5期334-340,共7页Chinese Journal of Urology

摘　　要：目的探讨肿瘤大体形态对上尿路尿路上皮癌(UTUC)患者根治手术后预后的影响。方法回顾性分析1998年1月至2019年6月浙江大学医学院附属第二医院(156例)和上海仁济医院(802例)收治的958例行根治手术的UTUC患者的临床和预后资料,男630例,女328例。中位年龄67(30~89)岁。合并糖尿病120例,高血压病370例。252例有吸烟史。499例术前伴肾积水。119例有非肌层浸润性膀胱癌(NMIBC)病史或合并NMIBC。肿瘤位于肾盂489例,输尿管394例,同时位于肾盂和输尿管75例。543例行腹腔镜手术,415例行开放手术。分析肿瘤大体形态与各临床病理因素的关系,运用Kaplan-Meier法及log-rank检验进行生存分析,采用Cox比例风险模型进行单因素和多因素分析,分析肿瘤大体形态和临床病理因素对预后的影响。结果本研究958例病理检查结果显示,516例(53.9%)肿瘤呈乳头状(A组),442例(46.1%)呈平坦状(B组);肿瘤直径≤3 cm 543例,>3cm 415例;病理分级低级别275例,高级别683例;病理分期Ta^1期441例,T2期180例,T3期308例,T4期29例;227例行淋巴结清扫,其中62例病理检查证实淋巴结转移;48例伴有鳞状或腺样分化;150例存在淋巴血管侵犯(LVI);134例为多灶性生长;43例切缘阳性。中位随访39(2~206)个月,304例死亡,其中236例因UTUC死亡。A组5年总生存率(OS)和肿瘤特异性生存率(CSS)分别为76.6%和81.8%,均明显高于B组的54.4%和60.5%(P均<0.001)。B组与A组在女性[38.9%(172/442)与30.3%(156/516),P=0.005]、输尿管占位[47.1%(208/442)与36.1%(186/516),P=0.002]、肾盂积水[55.9%(247/442)与48.8%(252/516),P=0.030]、术后辅助化疗[27.1%(120/442)与14.7%(76/516),P<0.001]、病理分级高级别[89.6%(396/442)与55.6%(287/516),P<0.001]、病理分期≥T2期[79.4%(350 /442)与32.4%(167/516),P<0.001]、淋巴结转移[12.0%(53/442)与1.7%(9/516),P<0.001]、伴鳞状或腺样分化[9.5%(42/442)与1.2%(6/516),P<0.001]和LVI[24.4%(108/442)与8.1%(42/516),P<0.001]方面�Objective To investigate the prognostic significance of tumor architecture in patients with upper tract urothelial carcinoma(UTUC)after radical nephroureterectomy.Methods A retrospective study was performed on 958 patients who underwent nephroureterectomy in Second Affiliated Hospital of Zhejiang university(156)and Renji Hospital(802)between January 1998 and June 2019.There were 630 males and 328 females with median age 67 years old,ranging 30-89 years old.Among them,499 patients suffered with preoperative hydronephrosis,370 patients suffered with hypertension,120 patients suffered with diabetes,252 patients had history of smoking and 119 patients had history of non-muscle invasive bladder cancer(NMIBC)or with NMIBC.489 patients had tumor in renal pelvic,394 patients had tumor in ureter and 75 patients had tumor in both sites.Laparoscopic surgery was performed in 543 patients while open surgery was performed in 415 patients.Theχ2 test was used to detect the association between tumor architecture and several clinicopathological features.Kaplan-Meier method with the log-rank test was used to assess survival analysis.Multivariate analyses were conducted using Cox proportional-hazards regression model.Results 516 cases(53.9%)showed papillary architecture(Group A)and 442 cases(46.1%)showed sessile architecture(Group B).543 patients had a tumor≤3 cm and 415 had a tumor>3 cm.Low pathological grade and high grade was diagnosed in 275 and 683 patients,respectively.The distribution of pathological stage was pTa-1 in 441 cases,pT2 in 180 cases,pT3 in 308 cases and pT4 in 29 cases.Lymphadenectomy was performed in 227 patients and 62 patients were pathologically confirmed lymph node metastasis.48 patients were found squamous or glandular differentiation.Lymphovascular invasion(LVI)was observed in 150 patients.134 patients were multifocality.Positive surgical margin was found in 43 patients.Median follow-up was 39(ranging,2-206)months.During follow-up,a total of 304 patients died and 236 died of UTUC.5-year OS and CSS were

关 键 词：泌尿系肿瘤 上尿路尿路上皮癌 肿瘤形态 根治性肾输尿管切除术 预后 

分 类 号：R737.1[医药卫生—肿瘤]