T2N0M0期上尿路尿路上皮癌患者预后相关因素分析:单中心235例患者回顾性研究

摘要

目的:分析T2N0M0上尿路尿路上皮癌(upper tract urothelial carcinoma, UTUC)患者长期生存情况以及预后相关因素.方法:回顾性分析2000年1月至2013年12月于北京大学第一医院行手术治疗的T2N0M0 UTUC患者的临床和随访资料,应用Kaplan-Meier法计算生存率,Log-rank方法进行单因素分析,对单因素分析中有统计学差异的变量采用Cox模型进行多因素生存分析.结果:共235例T2N0M0 UTUC患者纳入研究,中位随访时间53(3~142)个月.入组患者中男性95例(40.4%),女性140例(59.6%);患者平均年龄(66.73 ±10.49)岁,末次随访时共有74例(31.5%)患者因肿瘤死亡,96 例(40.9%)患者出现膀胱复发,中位死亡时间及复发时间分别为35个月和19.5个月.患者的3年和5年肿瘤特异性生存率分别为89.1%和85.9%;3年和5年无复发生存率分别为85.5%和80.2%.多因素分析发现,年龄大于55岁 (HR=3.138, 95%CI: 1.348~7.306, P=0.008)和肿瘤直径大于5 cm (HR=3.320, 95%CI: 1.882~5.857, P<0.001)是T2N0M0 UTUC患者术后肿瘤特异性死亡的独立危险因素;肿瘤发生在输尿管(HR=1.757, 95%CI: 1.159~2.664, P=0.008)和肿瘤低分级(HR=1.760, 95% CI: 1.151~2.692, P=0.009) 是T2N0M0膀胱复发的危险因素.结论:T2N0M0 UTUC患者肿瘤特异性生存预后较好,肿瘤复发率同非浸润性UTUC相当,但复发较早.肿瘤直径大于5 cm和年龄大于55岁是T2N0M0 UTUC肿瘤特异性死亡的独立危险因素;肿瘤发生在输尿管和肿瘤低分级是T2N0M0 UTUC膀胱复发的危险因素.%Objective: To evaluate the impacts of the prognostic factors of T2N0M0 upper tract urothelial carcinoma (UTUC) for Chinese patients.Methods: A retrospective study was conducted including 235 patients who were diagnosed with T2N0M0 UTUC in our hospital and received radical nephroureterectomy (RNU) or partial ureterectomy during January 2000 and December 2013.The 3 and 5-year can-cer-specific survival rates and bladder recurrence-free survival rates of all the patients were valued using Kaplan-Meier method, and the survival curves with statistical significance between the two were compared using the Log-rank test.Variables with significant differences in the univariate analysis were subjected to the multivariate analysis by Cox regression model.Results: A total of 235 patients were included in this study, including 95 (40.4%) male patients and 140 (59.6%) female patients.The mean age was 66.73±10.49 years.The median follow-up time was 53 (rang: 3-142) months, and during the follow-up, 74 (31.5%) patients died of UTUC after a median of 35 months,and 96 (40.9%) patients developed intravesical recurrence after a median of 19.5 months.The 3 and 5-year cancer-specific survival rates of all the patients were 89.1% and 85.9%, respectively;the bladder recurrence-free survival rates were 85.5% and 80.2%, respectively.The independent prognostic factors of cancer-specific mortality were tumor age elder than 55 years (HR=3.138, 95%CI: 1.348-7.306, P=0.008) and diameter larger than 5 cm (HR=3.320, 95%CI: 1.882-5.857, P<0.001).The independent prognostic factors of bladder recurrence-free survival were ureter tumor (HR=1.757, 95%CI: 1.159-2.664, P=0.008) and lower tumor grade (HR=1.760, 95% CI: 1.151-2.692, P=0.009).Conclusion: T2N0M0 UTUC has a better cancer-specific survival.The intravesical recurrence was equivalent to non-muscle invasive UTUC but earlier.The tumor diameter larger than 5 cm and the patient age elder than 55 years were independently associated with cancer-specific mortality;the primary tumor located in ureter and lower tumor grade were more likely to develop intravesical recurrence.