上尿路尿路上皮癌患者根治术后预后危险因素分析及风险分层模型构建  

Prognostic risk factors and risk stratification model for patients with upper tract urothelial carcinoma after radical nephroureterectomy

作　　者：赵子涵 朱文洁 王鑫[1] 孙逸凡 陈伟[1] 张士伟[1] 张古田[1] 李笑弓[1] 郭宏骞[1] 杨荣[1] ZHAO Zihan;ZHU Wenjie;WANG Xin;SUN Yifan;CHEN Wei;ZHANG Shiwei;ZHANG Gutian;LI Xiaogong;GUO Hongqian;YANG Rong(Department of Urology,Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Institute of Urology,Nanjing University,Nanjing,210023,China)

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科南京大学泌尿外科学研究所,南京210023

出　　处：《临床泌尿外科杂志》2021年第9期693-698,共6页Journal of Clinical Urology

基　　金：国家自然科学基金资助项目(No:81772727);江苏省科教强卫工程(No:ZDXKB2016014);南京市医学科技发展重点项目(No:ZKX19011)。

摘　　要：目的:分析接受根治性肾输尿管切除术(radical nephroureterectomy,RNU)的上尿路尿路上皮癌(upper tract urothelial carcinoma,UTUC)患者的预后危险因素以构建中国华东地区UTUC患者的预后风险分层模型。方法:收集南京大学医学院附属鼓楼医院2010年9月—2019年10月232例接受RNU的UTUC患者的临床资料、病理资料、血液学参数及随访资料进行回顾性分析。采用Cox回归模型分析影响癌症特异性生存(cancer-specific survival,CSS)的危险因素、Kaplan-Meier法绘制生存曲线、诺模图预测患者的5年CSS率,并且使用受试者工作(receiver operating characteristic,ROC)曲线检验风险分层模型的准确性。结果:232例患者中,男156例(67.2%),女76例(32.8%),病理分期(>T2)105例(45.3%),高级别肿瘤200例(86.2%),淋巴脉管侵犯(LVI)40例(17.2%),肿瘤侵犯神经18例(7.8%),手术切缘阳性15例(6.5%),乳头状肿瘤194例(83.6%)。中位随访时间为24个月,随访期间有38例(16.4%)患者死于UTUC。T分期(>T2)、存在LVI、手术切缘阳性、术中出血>170mL、术后未行膀胱灌注和术后低白蛋白水平是影响患者术后CSS的独立危险因素(P<0.05)。基于多因素Cox回归模型构建了中国华东地区UTUC患者的预后风险分层模型,高风险组及低风险组的5年CSS率分别为(45.0±8.4)%和(89.7±7.3)%(P<0.001)。ROC曲线分析显示该风险评分模型的曲线下面积(AUC)为0.841(P<0.001),敏感性和特异性分别为89.47%和62.37%。结论:在综合分析中国华东地区单中心UTUC患者的临床病理资料、血液学参数以及随访资料后,我们筛选出了影响患者预后的独立危险因素并构建了适合中国华东地区UTUC患者的预后风险分层模型。该模型具有良好的预后预测准确性,可以帮助临床医生在术后对患者进行及时评估,进而指导后续治疗。Objective:To analyze the prognostic risk factors of patients diagnosed with upper tract urothelial carcinoma(UTUC)who underwent radical nephroureterectomy(RNU)and construct a prognostic risk stratification model.Methods:The clinical data,pathological data,hematology parameters and follow-up data of 232patients with UTUC who received RNU from September 2010to October 2019in the Nanjing Drum Tower Hospital were collected for retrospective analysis.The Cox regression model was used to analyze the risk factors affecting cancer-specific survival(CSS),and the Kaplan-Meier analysis was used to describe the survival curve.The nomogram was used to predict the 5-year CSS of the patient,and the receiver operating characteristic(ROC)curve was used to test the accuracy of the risk stratification model.Results:Among the 232patients,156 were male(67.2%),and 76were female(32.8%),T stage(>T2)was 105(45.3%),200high-grade tumors(86.2%),lymphatic vessel invasion(LVI)was 40cases(17.2%),18cases(7.8%)with tumor invading nerves,15cases(6.5%)with positive surgical margins,and 194cases(83.6%)with papillary tumors.The median follow-up time and age were 24months and 68.5years,respectively.During the follow-up period,38patients(16.4%)died of UTUC.T stage(>T2),LVI,positive surgical margin,intraoperative bleeding(>170mL),without bladder perfusion after surgery,and low postoperative albumin levels are independent risk factors for CSS(P<0.05).Based on the multivariate Cox regression model,aprognostic risk stratification model was constructed for East China UTUC patients.The five-year CSS of the high-risk group and the low-risk group were(45.0±8.4)%and(89.7±7.3)%,respectively(P<0.001).ROC curve analysis showed that the area under curve(AUC)of the risk scoring model was 0.841(P<0.001),and the sensitivity and specificity were 89.47%and 62.37%,respectively.Conclusion:After comprehensively analyzing the clinicopathological data,hematology parameters and follow-up data of East China UTUC patients,we screened out independent risk factors that affect

关 键 词：上尿路尿路上皮癌 根治性肾输尿管切除术 预后 模型 癌症特异性生存 

分 类 号：R737[医药卫生—肿瘤]