上尿路尿路上皮癌淋巴结清扫术后局部复发和生存的危险因素分析  

Risk factors of local recurrence and survival in patients with upper tract urothelial carcinoma after nephroureterectomy with lymph node dissection

作　　者：袁昌巍 徐纯如 关豹 张崔健[1] 李晓颖[2] 何志嵩[1] 周利群[1] 李学松[1] Yuan Changwei;Xu Chunru;Guan Bao;Zhang Cuijian;Li Xiaoying;He Zhisong;Zhou Liqun;Li Xuesong(Department of Urology,Peking University First Hospital,Institute of Urology,Pelking University,NationalUrological Cancer Center,Bejing 100034,China;Department of Radiotherapy,Peking University First Hospital,Bejing 100034,China)

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,国家泌尿男生殖系肿瘤研究中心,北京100034 [2]北京大学第一医院放射治疗科,北京100034

出　　处：《中华泌尿外科杂志》2023年第9期641-647,共7页Chinese Journal of Urology

基　　金：中央高水平医院临床科研业务费资助(2022CR30)。

摘　　要：目的探讨上尿路尿路上皮癌(UTUC)淋巴结清扫术后患者局部复发和生存的危险因素。方法回顾性分析2010年1月至2022年3月于北京大学第一医院确诊为UTUC并行根治性肾输尿管切除+淋巴结清扫术237例患者的临床资料。男122例,女115例;年龄(65.52±10.14)岁;左侧122例,右侧115例;肾盂肿瘤102例,输尿管肿瘤124例,多部位肿瘤11例。根据病理结果淋巴结是否转移分为淋巴结阳性组和淋巴结阴性组。采用Kaplan-Meier法绘制生存曲线,采用log-rank检验评估两组的总生存率、肿瘤特异性生存率和无局部复发生存率。采用Cox比例风险回归分析影响患者总生存肿瘤特异性生存和局部复发的危险因素。结果本研究237例中,病理淋巴结阴性组180例(75.9%),淋巴结阳性组57例(24.1%)。淋巴结阳性组较淋巴结阴性组有更高比例的肾盂肿.瘤[57.9%(33/57)与38.1%(69/180)]、病理T_(3-4)期[84.2%(48/57)与32.8%(59/180)]、G,分级[91.2%(52/57)与55.6%(100/180)]、腺样分化[17.5%(10/57)与4.4%(8/180)]、肉瘤样分化[22.8%(13/57)与9.4%(17/180)]、坏死[47.4%(27/57)与16.1%(29/180)]和脉管癌栓[40.4%(23/57)与12.2%(22/180)],以及更高的中位淋巴结清扫数量[4(1,10)枚与2(1,5)枚],差异均有.统计学意义(P<0.05)。237例中,42例失访;195例获得随访,术后随访1~155个月,中位时间46(22,79)个月。随访期内58例(29.7%)出现局部复发,其中34例单纯局部复发,24例同时合并远处.转移。整体患者5年总生存率和肿瘤特异性生存率分别为67.4%和71.3%,,其中淋巴结阴性组分别为70.5%和75.1%,淋巴结阳性组分别为57.5%和59.4%,两组差异均有统计学意义(P<0.05)。总体3年无局部复发生存率为68.0%,其中淋巴结阴性组为75.6%,淋巴结阳性组为44.5%,两组差异有统计学意义(P<0.05)。多因素分析结果显示,肿瘤病理分期T_(3-4)期(HR=3.924,95%CI 2.045~7.529,P<0.001)、病理分级C,级(HR=2.871,95%C11.193~6.909,P=0.019)是局部复发的独立危�Objective To evaluate risk factors for local recurrence and prognosis in patients with upper tract urothelial carcinoma(UTUC)after radical nephroureterectomy combined with lymph node dissection(LND).Methods The data of 237 patients who were diagnosed with UTUC in Peking University First Hospital and received radical nephroureterectomy combined with LND during January 2010 and March 2022 were retrospectively reviewed.Clinicopathologic characteristics and oncological outcomes were compared according to lymph node metastasis.There were 122 males and 115 females.The tumors of 122 cases were located on the left,while 115 cases were on the right.The tumors of 102 cases were in the renal pelvic,124 cases in the ureter and 11 cases in both sites.The mean age was(65.52±10.14)years old.The overall survival(OS),cancer-specific survival(CSS),local recurrence-free survival(LRFS)of all patients were valued using Kaplan-Meier method,and the survival curves with statistical significance between two groups were analyzed by log-rank test.Univariate and multivariate Cox proportional hazards regressions were performed to identify the independent risk factors for CSS and LRFS.Results There were 122 males and 115 females.According to the lymph node metastasis,the patients were divided into lymph node negative group(n=180,75.9%)and lymph node positive group(n=57,24.1%).Lymph node positive group had a higher percentage in renal tumor[57.9%(33/57)vs.38.1%(69/180)],stage T_(3-4)[84.2%(48/57)vs.32.8%(59/180)],G_(3)[91.2%(52/57)vs.55.6%(100/180)],glandular differentiation[17.5%(10/57)vs.4.4%(8/180)],sarcomatoid differentiation[22.8%(13/57)vs.9.4%(17/180)],necrosis[47.4%(27/57)vs.16.1%(29/180)],lymphovascular invasion[40.4%(23/57)vs.12.2%(22/180)]and the number of lymph node dissection[4(1,10)vs.2(1,5)].There were significant differences between the two groups(P<0.05).Of 237 patients,42 lost of follow up.The median follow-up time was 46(22,79)months.Among the 195 patients,52 patients died,and 42 died due to the tumor.Of all patients,58(29.7

关 键 词：上尿路尿路上皮癌 淋巴结清扫 局部复发 预后 危险因素 

分 类 号：R737.1[医药卫生—肿瘤]