吸烟对上尿路尿路上皮癌GC方案辅助化疗的影响  

Effect of smoking on adjuvant chemotherapy with GC regimen for upper urinary tract urothelial carcinoma

作　　者：邢维思 黄瑞兆 王志强 王云[1] 肖荆[2] Xing Weisi;Huang Ruizhao;Wang Zhiqiang;Wang Yun;Xiao Jing(Department of Urology,the Second Clinical Medical College of Ningxia Medical University,the First People′s Hospital of Yinchuan,Yinchuan 750001,China;Department of Urology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]宁夏医科大学第二临床医学院,银川市第一人民医院泌尿外科,银川750001 [2]首都医科大学附属北京友谊医院泌尿外科,北京100050

出　　处：《国际外科学杂志》2024年第10期660-665,I0004,共7页International Journal of Surgery

基　　金：北京市中医药科技发展基金项目(JJ-2020-11)。

摘　　要：目的研究吸烟与上尿路尿路上皮癌(UTUC)患者临床病理的相关性,评估吸烟对UTUC患者吉西他滨联合顺铂(GC)方案辅助化疗预后的影响。方法采用回顾性队列研究方法,选取2013年1月—2021年12月于首都医科大学附属北京友谊医院接受半尿路切除术+膀胱袖状切除术并在术后行GC方案辅助化疗的91例患者,依据有无吸烟史将其分为吸烟组(n=33)和非吸烟组(n=58)。随访3~83个月,中位随访时间为38个月,统计分析两组患者的性别、年龄、有无肾积水、肿瘤分期、肿瘤是否多灶、淋巴血管浸润、淋巴结转移、肿瘤分级、总生存期(OS)及肿瘤特异性生存期(CSS)等指标。计量资料以均数±标准差(±s)表示,组间比较采用t检验;计数资料以例数和百分比[例(%)]表示,组间比较采用χ^(2)检验。生存分析比较采用Kaplan-Meier曲线表示,生存率的组间比较采用Long-rank检验。引入Cox比例风险回归模型,采用单因素和多因素Cox回归分析来探究OS和CSS的独立影响因素。结果91例患者中,男性41例,女性50例,中位年龄65岁,有19例(20.9%)患者死亡,其中17例(18.7%)死于UTUC。两组各项临床指标比较结果显示,吸烟与男性、肿瘤分期、肿瘤多灶性、淋巴血管浸润、淋巴结转移、肿瘤分级以及肾积水相关(P<0.05)。多因素Cox回归分析结果显示,吸烟、男性、肿瘤分期较高、淋巴血管浸润是OS和CSS的独立危险因素。对于吸烟的患者来说,吸烟时间会显著影响CSS,吸烟时间每增加1年,死亡的风险增加0.065。结论吸烟与UTUC患者不良病理相关,吸烟是UTUC患者术后GC方案辅助化疗预后的独立影响因素。ObjectiveTo study the correlation between smoking and clinicopathology in patients with upper tract urothelial carcinoma(UTUC),and to evaluate the effect of smoking on the prognosis of patients with UTUC treated with adjuvant chemotherapy for Gemcitabine plus Cisplatin(GC).MethodsA retrospective cohort study was used to select 91 patients who underwent resection of the kidney and ureter,and sleeve cystectomy in Beijing Friendship Hospital,Capital Medical University from January 2013 to December 2021,all patient received GC adjuvant chemotherapy after surgery.Patients were divided into smoking group(n=33)and non-smoking group(n=58)according to their smoking history.The median follow-up time was 38 months(3-83 months).The age,gender,presence or absence of hydronephrosis,tumor stage,multifocality,lymphatic vascular invasion,lymphatic metastasis,tumor grade,overall survival(OS)and cancer-specific survival(CSS)were statistically analyzed.The measurement data were expressed as mean±standard deviation(±s),and the t-test was used for comparison between groups;the count data were expressed as the number of cases and percentage,and the Chi-square test was used for comparison between groups.Kaplan-Meier curve was used for survival analysis and comparison,and Long-rank test was used for comparison between groups.Cox proportional risk regression model was introduced to explore the independent influencing factors of OS and CSS by univariate and multivariate Cox regression analysis.ResultsAmong 91 patients,41 were males and 50 were females,with a median age of 65 years,and 19 patients(20.9%)died,of which 17 patients(18.7%)died of UTUC.The comparison of clinical indicators between the two groups showed that smoking was associated with male,tumor stage,multifocality,lymphatic vascular invasion,lymphaitc metastasis,and tumor grade and hydronephrosis(P<0.05).Multivariate Cox regression analysis showed that smoking,male,higher tumor stage,and lymphatic vascular invasion were independent risk factors for OS and CSS.For the subgroup

关 键 词：吸烟 肿瘤 抗肿瘤联合化疗方案 尿路上皮 生存分析 

分 类 号：R737.1[医药卫生—肿瘤]