摘要
目的探讨上尿路尿路上皮癌伴鳞状或腺样分化的临床特点及预后。
方法 回顾性分析2001年1月至2014年12月收治的176例行根治术的上尿路尿路上皮癌患者的临床资料。男118例，女58例。年龄37～92岁，中位年龄70岁。根据术后病理是否伴鳞状或腺样分化分为A组（单纯上尿路尿路上皮癌组）和B组（伴鳞状或腺样分化组）。A组159例，男107例，女52例；年龄37～92岁，中位年龄70岁；肿瘤位于左侧91例，右侧68例；肾盂肿瘤74例，输尿管肿瘤62例，多灶性肿瘤23例；术前伴肾积水102例。B组17例，男11例，女6例；年龄44～90岁，中位年龄69岁；肿瘤位于左侧7例，右侧10例；肾盂肿瘤7例，输尿管肿瘤5例，多灶性肿瘤5例；术前伴肾积水14例。两组性别、年龄、肿瘤部位、肿瘤侧别、肾积水比较，差异均无统计学意义（均P〉0.05）。A、B组分别有32例（20.1%）和7例（41.2%）既往或同时伴发浅表性膀胱癌病史，两组差异有统计学意义（P＝0.047）。运用Kaplan－Meier法分析两组间术后生存率的差异，采用Cox比例风险模型法进行单因素和多因素分析。结果 176例中，鳞状分化10例（5.7%），腺样分化7例（4.0%）。B组较A组具有更高的肿瘤分期[≥pT2期肿瘤B组和A组分别为17例（100.0%）与114例（71.7%）]和更高的分级[B组和A组分别为12例（70.6%）与57例（35.8%）]，两组差异均有统计学意义（均P〈0.05）。Kaplan－Meier法分析结果显示，B、A组3年总生存率（overall survival，OS）分别为57.8%与78.9%，5年OS分别为30.8%与62.8%；3年肿瘤特异性生存率（cancer－specific survival，CSS）为63.5%与80.4%，5年CSS为33.9%与66.5%；B组术后OS和CSS均显著低于A组（均P〈0.05）。Cox多因素分析结果显示，伴鳞状或腺样分化是根治术后较低OS（P＝0.003）和CSS（P＝0.021）的独立危险因素，但不是膀胱无复发生存率（P＝0.097）的�
Objective To investigate the clinical characteristics and prognosis in upper urinary tract urothelial carcinoma concomitant with squamous or glandular differentiation.
Methods The medical records of 176 patients treated with radical nephroureterectomy from January 2001 to December 2014 were retrospectively reviewed. This total cohort included 118 men and 58 women. The median age was 70 years （range 37 to 92）. Ninety-eight cases had tumors in the left side and the remaining 78 cases in the right side. All eligible patients were divided into two groups according to the presence of squamous or glandular differentiation. One hundred and fifty-nine cases were in group A, including 107 men and 52 women. The median age of this group was 70 years （range 37 to 92）. Ninety-one cases had tumors in left side and the remaining 68 cases in right side. Seventeen cases were in group B, including 11 men and 6 women. The median age of this group was 69 years （range 44 to 90）. Seven cases had tumors in left side and the remaining 10 cases in right side. There was no significant difference in two groups about sex, age, tumor location, tumor side and existence of hydronephrosis （all P〉0.05）. Thirty-two cases（20.1%）and 7 cases（41.2%）in group A and B had previous or synchronous non-muscle-invasive bladder cancer（P=0.047）. Kaplan-Meier and Cox proportional hazard regression analysis were used to evaluate predictors of oncologic outcomes.Results Of the 176 patients, 10 （5.7%） had squamous differentiation and 7 （4.0%） had glandular differentiation. Comparing with pure urothelial carcinoma, concomitant squamous or glandular differentiation were more likely to have advanced tumor stage [≥pT2 in group B vs. group A： 17 cases（100.0%）vs. 114 cases（71.7%）] and high grade [12 cases（70.6%） vs. 57 cases（35.8%）] （all P〈0.05）. Overall survival （OS） rates at 3 years and 5 years in group B were significantly lower than those in group A （57.8% vs. 78.9% and 30.8% vs. 62.8%, respecti
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第8期595-599,共5页
Chinese Journal of Urology
关键词
上尿路尿路上皮癌
鳞状或腺样分化
预后
生存率
Upper urinary tract urothelial carcinoma
Squamous or glandular differentiation
Prognosis
Survival rate
