高佳宁, 刘静雅, 王欢, 马克如, 丁德鑫. 高级别且淋巴结阴性上尿路尿路上皮癌患者的不同转移部位的预后因素分析[J]. 中国肿瘤临床, 2023, 50(2): 70-75. DOI: 10.12354/j.issn.1000-8179.2023.20220937
引用本文: 高佳宁, 刘静雅, 王欢, 马克如, 丁德鑫. 高级别且淋巴结阴性上尿路尿路上皮癌患者的不同转移部位的预后因素分析[J]. 中国肿瘤临床, 2023, 50(2): 70-75. DOI: 10.12354/j.issn.1000-8179.2023.20220937
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Jianing Gao, Jingya Liu, Huan Wang, Keru Ma, Dexin Ding. Prognostic factors at different metastatic sites in high-grade node-negative upper tract urothelial carcinoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(2): 70-75. DOI: 10.12354/j.issn.1000-8179.2023.20220937
Citation: Jianing Gao, Jingya Liu, Huan Wang, Keru Ma, Dexin Ding. Prognostic factors at different metastatic sites in high-grade node-negative upper tract urothelial carcinoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(2): 70-75. DOI: 10.12354/j.issn.1000-8179.2023.20220937
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高级别且淋巴结阴性上尿路尿路上皮癌患者的不同转移部位的预后因素分析

Prognostic factors at different metastatic sites in high-grade node-negative upper tract urothelial carcinoma

    摘要
  • 摘要:
      目的  探讨根治性肾输尿管切除术（radical nephroureterectomy，RNU）后高级别且淋巴结阴性上尿路尿路上皮癌（upper tract urothelial carcinoma，UTUC）患者的不同转移部位对预后的影响。
      方法  回顾性分析2010年2月至2020年12月355例哈尔滨医科大学附属肿瘤医院行RNU后病理证实为高级别且淋巴结阴性UTUC患者的临床资料，行预后相关因素的单因素及Cox比例风险回归模型多因素分析。
      结果  355例患者中77例（21.7%）出现转移，93例（26.1%）死亡，中位随访时间为45个月，中位年龄为67岁。肝脏、骨骼和多部位转移的中位生存时间（overall survival，OS）分别为6、6和5个月。Cox比例风险回归模型多因素分析显示，膀胱内复发（intravesical recurrence，IVR）、肿瘤大小≥2 cm、肿瘤病理分期>T2期是患者转移的独立预测因素。
      结论  UTUC患者出现肝脏转移、骨转移和多部位转移相对较快，预后较差，而出现肺转移和淋巴结转移的预后相对较好。发生转移的晚期UTUC患者行同步放化疗、化疗联合免疫治疗的疗效优于未治疗、单独放疗和单独化疗者。

     

    Abstract:
      Objective  To investigate the effect of different metastatic sites on the prognosis of patients with high-grade node-negative upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).
      Methods  The clinical data of 355 patients with high-grade node-negative UTUC confirmed by pathology after RNU in Harbin Medical University Cancer Hospital from February 2010 to December 2020 were retrospectively analyzed. Univariate and multivariate analyses of prognostic factors were performed using Cox proportional hazards regression model.
      Results  Of the 355 patients, 77 (21.7%) had metastasis and 93 (26.1%) died. The median follow-up time was 45 months, and the median age was 67 years. The median overall survival (OS) of patients with liver, bone, and multiple metastases was 6, 6, and 5 months, respectively. Cox proportional hazards regression model multivariate analysis showed that intravesical recurrence (IVR), tumor size ≥ 2 cm, pathologic tumor stage > T2 are independent predictors of metastasis.
      Conclusions  The prognosis of UTUC patients with liver metastasis, bone metastasis and multiple metastasis is relatively poor, while the prognosis of lung metastasis and lymph node metastasis is relatively good. The efficacy of concurrent chemoradiotherapy and chemotherapy combined with immunotherapy in advanced UTUC patients with metastasis is better than that of untreated patients, radiotherapy alone, and chemotherapy alone.

     

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