影响输尿管移行细胞癌患者预后的术前因素
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摘要
目的评估输尿管移行细胞癌行输尿管肿瘤根治术术前预后相关预测因素。方法收集180例行输尿管肿瘤根治术的输尿管移行细胞癌患者的临床资料并对患者进行随访,评估术前相关预测因素对其预后的影响。结果肾积水程度、肿瘤位置、肿瘤最大长径、贫血、患侧肾功能、白蛋白-球蛋白比值(AGR)、高血小板症等因素与肿瘤的T分期具有相关性。肾积水程度、肿瘤最大长径、贫血、AGR、患侧肾功能、高血小板症等因素与肿瘤的分级具有相关性。存在多因素的高风险分组输尿管移行细胞癌患者的肿瘤预后较差,不同风险组间的预后具有显著的统计学意义(P<0.001)。结论输尿管移行细胞癌患者术前预测因素与肿瘤的T分期、肿瘤的分级具有相关性,并影响患者术后的肿瘤特定生存率(CSS)、无膀胱肿瘤复发生存率(RFS)、无远处转移生存率(MFS)。
Objective To evaluate the preoperative factors which could influence the prognosis of ureteral transitional cell carcinoma(UTCC).Methods A total of 180 UTCC patients treated with radical nephroureterectomy(RNU)were enrolled and followed up.The preoperative prognostic factors were analyzed.Results The degree of hydronephrosis,tumor location,tumor diameter,anemia,renal function of the affected side,A/G,and thrombocythemia were associated with tumor T staging and grading.Patients with multiple high risks showed poor prognosis.Patients with different risks showed different prognosis(P<0.001).Conclusion Preoperative prognostic factors correlate with tumor T staging and grading,and affect the cancer-specific survival(CSS),recurrence-free survival(RFS)and metastasis-free survival(MFS).
Objective To evaluate the preoperative factors which could influence the prognosis of ureteral transitional cell carcinoma(UTCC).Methods A total of 180 UTCC patients treated with radical nephroureterectomy(RNU)were enrolled and followed up.The preoperative prognostic factors were analyzed.Results The degree of hydronephrosis,tumor location,tumor diameter,anemia,renal function of the affected side,A/G,and thrombocythemia were associated with tumor T staging and grading.Patients with multiple high risks showed poor prognosis.Patients with different risks showed different prognosis(P<0.001).Conclusion Preoperative prognostic factors correlate with tumor T staging and grading,and affect the cancer-specific survival(CSS),recurrence-free survival(RFS)and metastasis-free survival(MFS).
引文
[1]ROUPRET M,BABJUK M,COMPERAT E,et al.European guidelines on upper tract urothelial carcinomas:2013update[J].Eur Urol 2013,63(6):1059-1071.
[2]MCCARROM JP,MillS C,VAUGHN ED JR.Tumors of the renal pelvis and ureter:current concepts and management[J].Seminars in Urology,1983,1(1):75.
[3]陈晓博,乔宝民,姜行康,等.肾积水程度和肿瘤直径作为输尿管移行细胞癌术前预测因素分析[J].天津医科大学学报,2015,21(03):236-238.
[4]张继伟,王海涛,阎乙夫,等.低分期和低分级原发性输尿管癌的临床特点分析[J].中华泌尿外科杂志,2013,34(10):742-745.
[5]邢云超,熊耕砚,方东,等.上尿路尿路上皮癌术前预后相关因素分析及初步风险分层模型构建[J].北京大学学报:医学版,2016,48(6):1032-1037.
[6]HOLST L M,JENSEN J B,BUE P,et al.Primary adenocarcinoma of the ureter[J].Ugeskrift Laeger,2009,171(7):534.
[7]刘刚,关英华,任小强,等.输尿管癌手术预后的临床病理多因素分析[J].肿瘤防治研究,2013,40(12):1163
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[9]CHUNG P H,KRABBE L M,DARWISH O M,et al.Degree of hydronephrosis predicts adverse pathological features and worse oncologic outcomes in patients with high-grade urothelial carcinoma of the upper urinary tract[J].Urol Oncol,2014,32(7):981-988.
[10]STRAVODIMOS K G,KORITSIADIS G,LAZARIS A C,et al.Hydronephrosis promotes expression of hypoxia-inducible factor1α[J].Urol Int,2009,82(1):38-42.
[11]CHEN C Y,LIAO Y M,TSAI W M,et al.Upper urinary tract urothelial carcinoma in eastern Taiwan:high proportion among all urothelial carcinomas and correlation with chronic kidney disease[J].J Formosan Med Assoc=Taiwan yi zhi,2007,106(12):992-998.
[12]FOX P,HUDSON M,BRONW C,et al.Markers of systemic inflammation predict survival in patients with advanced renal cell cancer[J].Br J Cancer,2013,109(1):147-153.
[13]FUKUSHIMA H,SAITO K,ISHIOKA J,et al.Equivalent survival and improved preservation of renal function after distal ureterectomy compared with nephroureterectomy in patients with urothelial carcinoma of the distal ureter:A propensity score‐matched multicenter study[J].Inte J Urol,2014,21(11):1098-1104.
[14]RINK M,SHARIFI N,FRITSCHE H M,et al.Impact of preoperative anemia on oncologic outcomes of upper tract urothelial carcinoma treated with radical nephroureterectomy[J].J Urol,2014,191(2):316-322.
[15]Kim H S,CHANG W J,KWAK C,et al.Can body mass index predict survival outcomes in patients treated with radical nephroureterectomy for upper-tract urothelial carcinoma?[J].Int Urol&Nephrolo,2015,47(8):1311-1320.
[16]BO Z,WEI Y,ZHOU L Q,et al.Prognostic Significance of Preoperative Albumin-Globulin Ratio in Patients with Upper Tract Urothelial Carcinoma[J].PLoS One,2015,10(12):e0144961.
[17]FOERSTER B,MOSCHINI M,ABUFARAJ M,et al.Predictive and prognostic value of preoperative thrombocytosis in upper tract urothelial carcinoma[J].Clin Genitourin Cancer,2017,15(6):1039-1045.
[18]PARK S,HONG B,KIM C S,et al.The impact of tumor location on prognosis of transitional cell carcinoma of the upper urinary tract[J].J Urol,2004,171(1):621-625.
[19]NARUKAWA T,HARA T,ARAI E,et al.Tumour multifocality and grade predict intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma without a history of bladder cancer[J].Japan J Clin Oncol,2015,45(5):488-493.
[2]MCCARROM JP,MillS C,VAUGHN ED JR.Tumors of the renal pelvis and ureter:current concepts and management[J].Seminars in Urology,1983,1(1):75.
[3]陈晓博,乔宝民,姜行康,等.肾积水程度和肿瘤直径作为输尿管移行细胞癌术前预测因素分析[J].天津医科大学学报,2015,21(03):236-238.
[4]张继伟,王海涛,阎乙夫,等.低分期和低分级原发性输尿管癌的临床特点分析[J].中华泌尿外科杂志,2013,34(10):742-745.
[5]邢云超,熊耕砚,方东,等.上尿路尿路上皮癌术前预后相关因素分析及初步风险分层模型构建[J].北京大学学报:医学版,2016,48(6):1032-1037.
[6]HOLST L M,JENSEN J B,BUE P,et al.Primary adenocarcinoma of the ureter[J].Ugeskrift Laeger,2009,171(7):534.
[7]刘刚,关英华,任小强,等.输尿管癌手术预后的临床病理多因素分析[J].肿瘤防治研究,2013,40(12):1163
[8]NG C K,SHARIAT S F,LUCARS S M,et al.Does the presence of hydronephrosis on preoperative axial CT imaging predict worse outcomes for patients undergoing nephroureterectomy for upper-tract urothelial carcinoma?[J].Urol Oncol Seminars&Original Invest,2011,29(1):27-32.
[9]CHUNG P H,KRABBE L M,DARWISH O M,et al.Degree of hydronephrosis predicts adverse pathological features and worse oncologic outcomes in patients with high-grade urothelial carcinoma of the upper urinary tract[J].Urol Oncol,2014,32(7):981-988.
[10]STRAVODIMOS K G,KORITSIADIS G,LAZARIS A C,et al.Hydronephrosis promotes expression of hypoxia-inducible factor1α[J].Urol Int,2009,82(1):38-42.
[11]CHEN C Y,LIAO Y M,TSAI W M,et al.Upper urinary tract urothelial carcinoma in eastern Taiwan:high proportion among all urothelial carcinomas and correlation with chronic kidney disease[J].J Formosan Med Assoc=Taiwan yi zhi,2007,106(12):992-998.
[12]FOX P,HUDSON M,BRONW C,et al.Markers of systemic inflammation predict survival in patients with advanced renal cell cancer[J].Br J Cancer,2013,109(1):147-153.
[13]FUKUSHIMA H,SAITO K,ISHIOKA J,et al.Equivalent survival and improved preservation of renal function after distal ureterectomy compared with nephroureterectomy in patients with urothelial carcinoma of the distal ureter:A propensity score‐matched multicenter study[J].Inte J Urol,2014,21(11):1098-1104.
[14]RINK M,SHARIFI N,FRITSCHE H M,et al.Impact of preoperative anemia on oncologic outcomes of upper tract urothelial carcinoma treated with radical nephroureterectomy[J].J Urol,2014,191(2):316-322.
[15]Kim H S,CHANG W J,KWAK C,et al.Can body mass index predict survival outcomes in patients treated with radical nephroureterectomy for upper-tract urothelial carcinoma?[J].Int Urol&Nephrolo,2015,47(8):1311-1320.
[16]BO Z,WEI Y,ZHOU L Q,et al.Prognostic Significance of Preoperative Albumin-Globulin Ratio in Patients with Upper Tract Urothelial Carcinoma[J].PLoS One,2015,10(12):e0144961.
[17]FOERSTER B,MOSCHINI M,ABUFARAJ M,et al.Predictive and prognostic value of preoperative thrombocytosis in upper tract urothelial carcinoma[J].Clin Genitourin Cancer,2017,15(6):1039-1045.
[18]PARK S,HONG B,KIM C S,et al.The impact of tumor location on prognosis of transitional cell carcinoma of the upper urinary tract[J].J Urol,2004,171(1):621-625.
[19]NARUKAWA T,HARA T,ARAI E,et al.Tumour multifocality and grade predict intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma without a history of bladder cancer[J].Japan J Clin Oncol,2015,45(5):488-493.