原发肿瘤部位对上尿路上皮癌患者生存的影响及相关预后列线图模型的开发与验证  

Effects of tumor location on the prognosis of upper tract urothelial carcinoma and development and validation of a prognostic nomogram

作　　者：王泽伟 李海龙 李港 高志民 温儒民 WANG Zewei;LI Hailong;LI Gang;GAO Zhimin;WEN Rumin(Department of Urology,The Affiliated Hospital of Xuzhou Medical University;Graduate School,Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]徐州医科大学附属医院泌尿外科 [2]徐州医科大学研究生院,江苏徐州221002

出　　处：《现代泌尿外科杂志》2024年第2期146-153,共8页Journal of Modern Urology

摘　　要：目的本文旨在探讨原发肿瘤部位对接受根治性肾输尿管切除术(RNU)治疗的上尿路上皮癌(UTUC)患者预后的影响,并开发和验证预测患者术后总生存期(OS)的列线图模型。方法回顾性收集2010年1月-2022年12月于徐州医科大学附属医院泌尿外科接受RNU的UTUC患者。其中70%的患者纳入训练组,30%的患者纳入验证组。基于原发肿瘤部位将患者分为肾盂肿瘤(RPT)组和输尿管肿瘤(UT)组,分析不同部位UTUC患者的临床病理特征和预后差异。根据多因素Cox回归模型结果开发预测患者术后OS的列线图模型并进行验证。结果最终366例患者(RPT 196例、UT 170例)被纳入本研究中。RPT组与UT组在尿细胞学检查(P=0.001)、术前同侧肾积水(P<0.001)、膀胱肿瘤病史(P=0.021)、病理T分期(P<0.001)和组织学结构(P=0.037)方面比较差异有统计学意义。多因素Cox回归模型结果显示:UT患者较RPT患者预后更差(HR=2.00,95%CI:1.22~3.27,P=0.006)。构建预测患者术后OS列线图的指标包括:年龄、肿瘤部位、淋巴血管侵犯和病理T分期。模型显示出较好的区分度与校准度,并在内部验证中表现稳定。结论与RPT相比,UT患者预后更差,建议对UT患者肿瘤周围的脂肪进行更为彻底的手术清扫,以免发生肿瘤术后微残留;我们成功构建了可用于预测UTUC患者RUN术后OS的列线图模型。Objective To investigate the prognostic value of tumor location in patients with upper tract urothelial carcinoma(UTUC)treated with radical nephroureterectomy(RNU),and to develop and validate a nomogram model for predicting the overall survival(OS).Methods UTUC patients undergoing RUN at our hospital during Jan.2010 and Dec.2022 were retrospectively collected,70%of whom were included in the training group and 30%in the validation group.According to the tumor location,patients were divided into renal pelvis tumor(RPT)group and ureteral tumor(UT)group.The differences in clinicopathological features and prognosis were analyzed.Based on multivariate Cox results,a nomogram model for predicting OS was developed and validated.Results A total of 366 patients(196 RPT and 170 UT)were included in this study.There were statistically significantly differences in urine cytology(P=0.001),hydronephrosis(P<0.001),history of bladder tumor(P=0.021),pathological T stage(P<0.001)and histological structure(P=0.037)between the two groups.Multivariate Cox results showed that patients with UT had a worse prognosis(HR=2.00,95%CI:1.22-3.27,P=0.006).Factors of the nomogram for predicting OS included age,tumor location,lymphovascular invasion and pathological T stage.The model showed good discrimination and calibration,and performed well in internal verification.Conclusion Compared with RPT,UT has a worse prognosis and the fat around the tumor should be surgically removed more thoroughly to avoid micro-residual.We successfully coustructed a nomogram model that can be used to predict the OS of UTUC patients after RNU surgery.

关 键 词：肿瘤位置 上尿路上皮癌 肾盂癌 输尿管癌 根治性肾输尿管切除术 总生存期 列线图模型 

分 类 号：R737.1[医药卫生—肿瘤]