上尿路尿路上皮癌预后及术后复发膀胱癌的危险因素分析
摘要
目的探讨上尿路尿路上皮癌临床与病理特点对术后膀胱癌的复发规律及对预后的影响。
方法回顾107例上尿路尿路上皮癌病例的临床与病理特点，对预后以及术后复发膀胱癌情况分别作Kaplan-Meier曲线单因素分析，并行Log-rank检验，再应用Cox比例风险模型分析，P＜0.05为差异有统计学意义。
结果107例上尿路尿路上皮癌病人术后复发膀胱癌为29.0％(31／107)，复发时间为术后4个月—7年，再发于2年内的占71.0％(22／31)。全部病例、未复发膀胱癌者和复发膀胱癌者的5年存活率分别为62.4％、78.0％和31.5％。在多因素分析中，肿瘤多部位生长和病理分期对术后复发膀胱癌有显著影响，其相对危险度分别为0.9868和2.4706，相关系数小；与术后存活率显著相关的因素只有病理分期，相对危险度为1.7204。
结论有无多部位生长和病理分期为术后复发膀胱癌的危险因素，提示多部位生长和(或)高分期的原发上尿路尿路上皮癌术后应密切随访膀胱情况，多部位生长上尿路尿路上皮癌术后复发膀胱癌者明显高于单发者，如原单发上皮癌为浸润性，复发膀胱癌的风险也同样增加；病理分期对存活率有显著影响。为临床疾病的治疗及预后提供更准确的参考和指导。
Objective To study the clinicopathological features and prognosis of upper urinary tract epithelial carcinoma with intravesical occurrence.
Methods The clinicopathological features of 107 cases of urinary tract epithelial carcinoma were retrospectively studied. Cox's analysis, Kaplan Meier function and logrank test were used to assess the influence of the intravesical occurrence of the cancer. P＜0.05 was considered to indicate statistical significance.
Results There were 31cases with intravesical occurrence out of 107 after kidney ureter and partial bladder resection. Of these 31 patients, 22 (71.0%) developed bladder cancer within 2 years of total nephroureterectomy. The five years survival rate of the totle patiens, the patients without bladder cancer and the patients with bladder cancer were 62.4%, 78.0% and 31.5%, respectively. On multivariate analysis, the multiplace growth and the pathologic stage of the primary cancer were significantly related to the occurrence of intravesical occurrence of the cancer after surgical management. Their OR values were 0.9868 and 2.4706, with the coefficient correlation being low. The pathologic stage of the primary cancer were the only significant factors for prognosis, with a hazard index of 1.7204.
Conclusions The OR value and hazard index of the factors above can be estimated to evaluate the prognosis including recurrence of bladder carcinoma and survival rate. Careful follow up for bladder recurrence is important.
方法回顾107例上尿路尿路上皮癌病例的临床与病理特点，对预后以及术后复发膀胱癌情况分别作Kaplan-Meier曲线单因素分析，并行Log-rank检验，再应用Cox比例风险模型分析，P＜0.05为差异有统计学意义。
结果107例上尿路尿路上皮癌病人术后复发膀胱癌为29.0％(31／107)，复发时间为术后4个月—7年，再发于2年内的占71.0％(22／31)。全部病例、未复发膀胱癌者和复发膀胱癌者的5年存活率分别为62.4％、78.0％和31.5％。在多因素分析中，肿瘤多部位生长和病理分期对术后复发膀胱癌有显著影响，其相对危险度分别为0.9868和2.4706，相关系数小；与术后存活率显著相关的因素只有病理分期，相对危险度为1.7204。
结论有无多部位生长和病理分期为术后复发膀胱癌的危险因素，提示多部位生长和(或)高分期的原发上尿路尿路上皮癌术后应密切随访膀胱情况，多部位生长上尿路尿路上皮癌术后复发膀胱癌者明显高于单发者，如原单发上皮癌为浸润性，复发膀胱癌的风险也同样增加；病理分期对存活率有显著影响。为临床疾病的治疗及预后提供更准确的参考和指导。
Objective To study the clinicopathological features and prognosis of upper urinary tract epithelial carcinoma with intravesical occurrence.
Methods The clinicopathological features of 107 cases of urinary tract epithelial carcinoma were retrospectively studied. Cox's analysis, Kaplan Meier function and logrank test were used to assess the influence of the intravesical occurrence of the cancer. P＜0.05 was considered to indicate statistical significance.
Results There were 31cases with intravesical occurrence out of 107 after kidney ureter and partial bladder resection. Of these 31 patients, 22 (71.0%) developed bladder cancer within 2 years of total nephroureterectomy. The five years survival rate of the totle patiens, the patients without bladder cancer and the patients with bladder cancer were 62.4%, 78.0% and 31.5%, respectively. On multivariate analysis, the multiplace growth and the pathologic stage of the primary cancer were significantly related to the occurrence of intravesical occurrence of the cancer after surgical management. Their OR values were 0.9868 and 2.4706, with the coefficient correlation being low. The pathologic stage of the primary cancer were the only significant factors for prognosis, with a hazard index of 1.7204.
Conclusions The OR value and hazard index of the factors above can be estimated to evaluate the prognosis including recurrence of bladder carcinoma and survival rate. Careful follow up for bladder recurrence is important.
引文
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3 Hisataki T, Miyao N, Masumori N, et al. Risk factors for the development of bladder cancer after upper tract urothelial cancer. Urology 2000;55:663_/7.
4 Koga F, Nagamatsu H, Ishimaru H, Mizuo T, Yoshida K. Risk factors for the development of bladder transitional cell carcinoma following surgery for transitional cell carcinoma of the upper urinary tract. Urol Int 2001;67:135_/41.
5 Hall MC, Womack S, Sagalowsky AI, Carmody T, Erickstat MD, Roehrborn CG. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology 1998;52:594_/601.
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7 Raman JD, Ng CK, Boorjian SA, et al. Bladder cancer after managing upper urinary tract transitional cell carcinoma: predictive factors and pathology. BJU Int. 2005 Nov;96(7):1031-5.
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13 Simon R,Eltze E,Schafer KL,et al.Cytogenetic analysis of multifocal bladder cancer supports amonoclonal origin and intraepithelial spread of tumor cells. Cancer Res, 2001, 61(1), 355-62.
14 Cianciulli AM, Leonardo C, Guadagni F, et al. Genetic instability in superficial bladder cancer and adjacent mucosa:an interphase cytogenetic study. Hum Pathol, 2003, 34(3), 214-21
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17 Kang CH, Yu TJ, Hsieh HH et al. The development of bladder tumors and contralateral upper urinary tract tumors after primary transitional cell carcinoma of the upper urinary tract. Cancer 2003; 98: 1620-6
18 Matsui Y, Utsunomiya N, Ichioka K et al. Risk factors for subsequent development of bladder cancer after primary transitional cell carcinoma of the upper urinary tract. Urology 2005; 65: 279-83
19 Krogh J, Kvist E, Rye B. Transitional cell carcinoma of the upper urinary tract: prognostic variables and post-operative recurrences. Br J Urol 1991; 67: 32-6
20 Hafner C, Knuechel R, Zanardo L, et al. Evidence for oligoclonality and tumor spread by intraluminal seeding in multifocal urothelial carcinomas of the upper and lower urinary tract[J]. Oncogene, 2001, 20: 4910-4915.
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