摘要
目的探讨上尿路尿路上皮癌（UTUC）患者的性别差异及其预后。
方法回顾性分析2000年1月至2014年12月收治的942例UTUC患者的临床病理资料。男424例，女518例。年龄20～93岁，平均64.5岁。根据患者性别不同，将患者分为两组。男性年龄（63.7±16.8）岁，既往有UTUC病史11例（2.6%），膀胱癌病史25例（5.9%），肾移植病史6例（1.4%），术前有吸烟史126例（29.7%），术前有马兜铃酸相关药物服用史22例（5.2%），术前37例（8.7%）行输尿管镜检查，eGFR为（56.5±27.1） ml/（min·1.73m2）。女性年龄（65.3±15.4）岁，既往有UTUC病史18例（3.5%），膀胱癌病史28例（5.4%），肾移植病史11例（2.1%），术前有吸烟史58例（5.2%），术前有马兜铃酸相关药物服用史58例（11.2%），术前54例（10.4%）行输尿管镜检查，术前eGFR为（51.7±27.1） ml/（min·1.73m2）。在年龄、既往病史、术前输尿管镜检查等方面，两组差异无统计学意义（均P〉0.05）。与男性患者相比，女性较少吸烟（P〈0.001），却更多存在马兜铃酸相关药物服用史（P＝0.001），且女性患者术前肾功能差于男性（P＝0.023）。通过单因素分析比较UTUC病理特点的性别差异，通过Kaplan-Meier生存分析法分析UTUC患者肿瘤特异性生存、膀胱复发及对侧上尿路复发的性别差异。
结果与男性患者相比，女性患者肿瘤局部进展（T3～T4）比例较低（33.7%与24.9%, P＝0.003）。术后随访4～193个月，平均70.2个月。男性总体肿瘤特异性生存率低于女性（χ2＝14.116，P〈0.001），男性、女性5年CSS分别为72.0%和83.5%；而女性对侧尿路上皮总体无复发生存率低于男性（χ2＝7.362，P＝0.007），男性、女性5年对侧尿路上皮无复发生存率分别为98.6%和92.9%。
结论UTUC患者女性比例偏高，女性有更多服用马兜铃酸相关药物史，其肿瘤分期较低，却更易出现对侧尿路�
ObjectiveTo assess the gender-related differences of upper tract urothelial carcinoma and analyze the causes of the gender-related differences.
MethodsWe retrospectively studied 942 patients underwent radical nephroureterectomy for upper tract urothelial carcinoma between January 2000 and December 2014 in our hospital. The mean age of the entire cohort was 64.5 years, with 424 males （45.0%） and 518 females （55.0%）. Compared with male patients, female patients tended to had a history of aristolochic acids exposure （5.2% vs. 11.1%, P=0.001）, infrequent smoking （29.7% vs. 5.2%, P〈0.001） and showed poorer renal function （P=0.023）. We reviewed clinicopathologic data from these patients and used univariate analysis to determine the gender-related differences. The Kaplan-Meier method was adopted to investigate the gender differences of cancer specific survival, bladder recurrence-free survival and contralateral upper tract recurrence-free survival of patients.
ResultsWhen compared with males, females were less likely to have high-stage disease （33.7% vs. 24.9%, P=0.003）. The mean follow-up for the entire cohort was 70.2 months （4-193 months）. The cancer specific survival rate （χ2=14.116, P〈0.001）and the contralateral upper urinary tract recurrence rate（χ2=7.362, P=0.007）in females were both higher than those in males. The 5-year cancer specific survival rates were 72.0% in the males and 83.5% in females, respectively. In addition, the 5-year contralateral UTUC-free survival rates were 98.6% in the males and 92.9% in females.
ConclusionsFemale patients in our cohort were more common and they were more likely to be exposed to aristolochic acids. Females were less likely to have high-stage disease but had significantly worse contralateral upper tract recurrence-free survival.
作者
钟文龙
熊耕砚
张雷
方冬
李学松
周利群
Zhong Wenlong;Xiong Gengyan;Zhang Lei;Fang Dong;Li Xuesong;Zhou Liqun.(Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第12期901-904,共4页
Chinese Journal of Urology
基金
北京自然科学基金（7152146）
首都卫生发展科研专攻重点公关项目（2016-1-4077）
北京市科技计划项目（首都临床特色应用研究）（Z151100004015173）
关键词
上尿路尿路上皮癌
性别
预后
马兜铃酸
Upper tract urothelial carcinoma（UTUC）
Gender
Prognosis
Aristolochic acid
