上尿路尿路上皮癌根治术后生存情况及危险因素  

Survival and risk factors analysis of urothelial carcinoma of upper urinary tract after radical surgery

作　　者：员海超 柳良仁[2] 杨尚琪[1] 王燕[1] 赵正平[1] 胡祎民[1] YUAN Haichao;LIU Liangren;YANG Shangqi;WANG Yan;ZHAO Zhengping;HU Yimin(Department of Urology,Peking University Shenzhen Hospital,Shenzhen 518000,Guangdong,China;Department of Urology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]北京大学深圳医院泌尿外科,广东深圳518000 [2]四川大学华西医院泌尿外科,四川成都610041

出　　处：《西部医学》2021年第10期1531-1535,共5页Medical Journal of West China

基　　金：深圳市卫生计生系统博士创新项目(SZBC2017021)。

摘　　要：目的探讨上尿路尿路上皮癌(UTUC)根治术后长期生存情况及相关危险因素。方法回顾性分析2011年1月~2019年1月北京大学深圳医院和四川大学华西医院收治的419例UTUC患者的临床病理资料。采用EmpowerStats统计软件处理数据。采用Kaplan-Meier法和log-rank检验对各组间生存率进行单因素分析,对有统计学意义的因素采用Cox比例风险回归模型行多因素分析。分析影响无病生存期(DFS)和总生存期(OS)的独立预后因素。结果419例平均随访30.7个月(1~130个月)。171例发生疾病复发或进展导致死亡,中位间歇期为14.9个月(1~100个月);196例发生死亡,中位间歇期为19.9个月(1~97个月)。单因素分析结果显示,肾图评分肾功能受损(P<0.018)、NLR>2.589(P<0.001)、肿瘤多灶性(P<0.003)、肿瘤最大直径>3 cm(P<0.001)、LVI阳性(P<0.001)、肿瘤高级别(P<0.001)、病理分期中T2~T4(P<0.001)和DFS、OS密切相关。多因素分析结果显示,NLR>2.589(HR=2.083,P=0.001)、肿瘤最大直径>3 cm(HR=2.214,P=0.001)、LVI阳性(HR=1.719,P=0.012)、高级别(HR=5.042,P=0.002)、病理分期中T2~T4(HR=9.868,P=0.001)是DFS的独立预后影响因素。NLR>2.589(HR=2.271,P=0.001)、肿瘤最大直径>3 cm(HR=2.303,P=0.001)、LVI阳性(HR=1.807,P=0.003)、高级别(HR=4.712,P=0.001)、病理分期中T2~T4(HR=11.619,P=0.001)是OS的独立预后影响因素。无病生存期低危组1、3、5年DFS分别为93.2%、87.0%、85.1%;高危组分别为64.3%、42.5%、40.6%,2组间差异有统计学意义(P<0.0001)。总生存期低危组1、3、5年DFS分别为94.6%、90.2%、84V0%;高危组分别为69.2%、41.0%、32.9%,两组间差异有统计学意义(P<0.0001)。结论NLR>2.589、肿瘤最大直径>3 cm、LVI阳性、高级别、病理分期中T2~T4是影响UTUC患者术后无病生存期和总生存期的独立危险因素。以此建立的危险分层模型对高危患者的判断具有意义。Objective To analyze the long-term survival and related risk factors of patients with upper urinary tract urothelial carcinoma(UTUC)after radical surgery.Methods The clinical pathological data of 419 UTUC patients admitted from January 2011 to January 2019 were retrospectively analyzed.Data processing and statistical analysis using EmpowerStats statistical software,Kaplan-Meier method and Log-rank test were used for univariate analysis of survival rate among groups.Cox proportional risk regression model was used for multivariate analysis of statistically significant factors.Independent prognostic factors for disease-free survival(DFS)and Overall survival(OS)were analyzed.Results 419 cases were followed up for an average of 30.7 months(1~130 months).171 cases died due to disease recurrence or progression.The median interval was 14.9 months(1~100 months).196 cases died.The median interval was 19.9 months(1~97 months).Univariate analysis showed that the renogram score showed impaired renal function(<0.018),NLR>2.589(<0.001),multifocal tumor(<0.003),maximum tumor diameter>3 cm(<0.001),LVI positive(<0.001),high-grade tumor(<0.001),T2~T4(<0.001),DFS OS is closely related.Multivariate analysis showed that NLR>2.589(HR=2.083,P=0.001),maximum tumor diameter>3 cm(HR=2.214,P=0.001),LVI positive(HR=1.719,P=0.012),high grade(HR=5.042,P=0.002),T2~T4(HR=9.868,P=0.001)in pathological stage were independent prognostic factors of DFS.NLR>2.589(HR=2.271,P=0.001),maximum tumor diameter>3 cm(HR=2.303,P=0.001),LVI positive(HR=1.807,P=0.003),high grade(HR=4.712,P=0.001),T2~T4(HR=11.619,P=0.001)in pathological stage were independent prognostic factors of OS.The DFS at 1,3 and 5 years in the low-risk disease-free survival group were 93.2%,87.0%and 85.1%respectively.The high-risk groups were 64.3%,42.5%and 40.6%respectively.There was significant difference between the two groups(P<0.0001).The DFS of 1,3 and 5 years in the low-risk group were 94.6%,90.2%and 84.0%respectively,and those in the high-risk group were 69.2%,41.0%and 32.9%respect

关 键 词：上尿路尿路上皮癌 根治术 生存期 危险分层 预后 

分 类 号：R737.1[医药卫生—肿瘤]