原发性尿道癌的临床特征和预后分析  

Clinical characteristics and prognosis analysis of primary urethral malignant tumors

作　　者：司马晨阳 丁亚飞[1] 汪涛[1] 黄珍林 贾占奎[1] 杨锦建[1] Sima Chenyang;Ding Yafei;Wang Tao;Huang Zhenlin;Jia Zhankui;Yang Jinjian(Urology Department,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院泌尿外科,郑州450052

出　　处：《中华泌尿外科杂志》2023年第6期452-458,共7页Chinese Journal of Urology

摘　　要：目的探讨原发性尿道癌的临床特点和影响预后的因素。方法回顾性分析2011年1月至2022年4月郑州大学第一附属医院收治的35例原发性尿道癌患者的临床资料。男12例(34.3%),女23例(65.7%)。年龄(61.1±13.0)岁。临床症状包括尿道梗阻13例(37.1%),血尿7例(20.0%),尿道出血6例(17.1%),尿路刺激症状5例(14.3%),尿失禁1例(2.9%),腰痛1例(2.9%),阴囊溃疡1例(2.9%),自行查体发现1例(2.9%)。所有患者均行膀胱尿道镜检查,活检病理为尿路上皮癌16例,鳞癌7例,腺癌4例,恶性黑色素瘤3例,尿路上皮癌合并鳞癌1例,印戒细胞癌1例,肉瘤样癌1例,胚胎型横纹肌肉瘤1例,上皮样血管肉瘤1例。肿瘤位于近端尿道13例(37.1%),远端尿道22例(62.9%)。肿瘤最大径<3cm14例(40.0%),≥3cm16例(45.7%),仅表现为黏膜异常5例(14.3%)。肿瘤分期T_(1)期12例,T_(2)期9例,T_(3)期7例,T_(4)期7例。影像学检查评估淋巴结:N_(1)期25例,N_(2)期2例,N2期8例。术前3例行淋巴结活检,术中8例清扫盆腔和双侧腹股沟淋巴结,病理检查提示6例淋巴结转移。1例初诊时伴远处转移。31例行手术治疗,16例行根治性尿道切除术,8例行尿道肿物切除术,7例行经尿道肿瘤电切术。4例未行手术治疗,1例为上皮样血管肉瘤,行放疗联合化疗;2例行吉西他滨+顺铂方案化疗;1例应用免疫检查点抑制剂治疗。分析影响患者预后的危险因素。结果本组35例均获得随访,中位随访时间22(2,122)个月。17例生存,18例死亡,总体中位生存时间23(13,未达到)个月。总体5年生存率45%。单因素分析结果显示,临床T分期(P=0.019)、肿瘤最大径(P=0.016)和肿瘤位置(P=0.006)是影响患者预后的独立危险因素。多因素分析结果显示,肿瘤最大径≥3cm(HR=2.673,P=0.029)和肿瘤位于近端尿道(HR=3.064,P=0.023)是影响患者预后的独立危险因素。性别、年龄、治疗方式、淋巴结清扫、辅助放疗、辅助化疗、临床表现、病理类型Objective To investigate the clinical characteristics and prognostic factors of primary urethral cancer.Methods The clinical data of 35 patients with primary urethral cancer admitted to the First Affiliated Hospital of Zhengzhou University from January 2011 to April 2022 were retrospectively analyzed.There were 12 males(34.3%)and 23 females(65.7%).The average age was 61.1±13.0 years old.The clinical symptoms included 13 cases of urethral obstruction(37.1%),7 cases of hematuria(20.0%),6 cases of urethral bleeding(17.1%),5 cases of urinary tract irritation(14.3%),1 case of Urinary incontinence(2.9%),1 case of low back pain(2.9%),1 case of scrotal ulcer(2.9%),and 1 case(2.9%)by self examination.All patients underwent cystourethroscopy and tissue biopsy.The biopsy pathology showed 16 cases of urothelial carcinoma,7 cases of squamous carcinoma,4 cases of adenocarcinoma,3 cases of malignant melanoma,1 case of urothelial carcinoma with squamous carcinoma,1 case of Signet ring cell carcinoma,1 case of sarcomatoid carcinoma,1 case of embryonic Rhabdomyosarcoma,and 1 case of epithelioid angiosarcoma.The tumors were located in the proximal urethra in 13 cases(37.1%)and in the distal urethra in 22 cases(62.9%).There were 14 cases(40.0%)with a maximum diameter of less than 3 cm,16 cases(45.7%)with a diameter of≥3 cm,and 5 cases(14.3%)with mucosal abnormalities.There were 12 cases of T_(1) stage,9 cases of T_(2) stage,7 cases of T_(3) stage,and 7 cases of T_(4) stage in tumor staging.Imaging evaluation of lymph nodes showed 25 cases of N_(0)stage,2 cases of N_(1)stage,and 8 cases of N_(2) stage;A tota l of 1l cases of lymph node biopsy were performed(including 8 cases of intraoperative lymph node dissection and 3 cases of preoperative lymph node biopsy),of which 6 cases had lymph node metastasis,and 1 case was initially diagnosed with distant metastasis.Thirty-one cases underwent surgical treatment,of which 16 cases underwent radical urethrectomy,and 8 cases underwent intraoperative pelvic and bilateral inguinal lymph node

关 键 词：原发性 尿道肿瘤 临床特征 预后 

分 类 号：R737.15[医药卫生—肿瘤]