| 摘要: |
| 目的 探讨上尿路尿路上皮癌（UTUC）手术治疗后膀胱复发的危险因素。方法 收集2008年1月至2017年12月在我院行手术治疗且随访资料完整的445例UTUC患者病例资料。分析患者的基线数据、手术方法、术后病理结果、随访数据等资料，采用单因素和多因素Cox回归模型分析与UTUC术后膀胱复发相关的危险因素。结果 本研究纳入UTUC患者的术后中位随访时间为33.5个月，UTUC术后膀胱复发率为18.0%（80/445），其中66.2%（53/80）的患者膀胱初次复发发生于术后1年内。单因素Cox回归分析发现患者年龄≥65岁（OR=1.99，95% CI：1.22～3.22，P<0.01）、有膀胱癌病史（OR=2.69，95% CI：1.71～4.24，P<0.01）、行保留肾单位肿瘤局部切除术（OR=2.15，95% CI：1.30～3.57，P<0.01）、输尿管下段肿瘤（OR=1.40，95% CI：1.11～1.78，P<0.01）与UTUC术后膀胱复发密切相关。将上述危险因素纳入多因素Cox回归模型，发现其均为UTUC术后膀胱复发的独立危险因素。结论 年龄≥65岁、有膀胱癌病史、行保留肾单位肿瘤局部切除术、输尿管下段肿瘤是UTUC术后膀胱复发的独立危险因素，存在上述危险因素的UTUC患者术后需加强随访监测，定期复查膀胱镜。 |
| 关键词: 上尿路 尿路上皮癌 复发 膀胱肿瘤 危险因素 |
| DOI：10.16781/j.0258-879x.2018.05.0469 |
| 投稿时间：2018-03-27修订日期：2018-03-27 |
| 基金项目:国家自然科学基金（81772720），上海市青年科技英才扬帆计划（18YF1422700），第二军医大学青年启动基金（2017QN11）. |
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| Risk factors of intravesical recurrence after upper-tract urothelial carcinoma surgery |
| REN Qian△,ZENG Shu-xiong△,TANG Shi-jie,DAI Li-he,XU Jin-shan,SUN Ying-hao,XU Chuan-liang* |
(Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), Shanghai 200433, China
△Co-first authors.
*Corresponding author) |
| Abstract: |
| Objective To explore the risk factors of intravesical recurrence (IVR) of upper-tract urothelial carcinoma (UTUC) after surgery. Methods The medical records of 445 patients with complete follow-up data and undergoing UTUC surgery in our hospital from Jan. 2008 to Dec. 2017 were collected in this study. The baseline demographics, surgical methods, postoperative pathology, follow-up data and other related information were analyzed. Risk factors of the IVR were analyzed by univariate and multivariate Cox regression models. Results The median follow-up time was 33.5 months, and the IVR rate was 18.0% (80/445), of which 66.2% (53/80) occurred within one year after surgery. Univariate Cox analysis revealed that aged ≥ 65 years old (odds ratio[OR]=1.99, 95% confidence interval[CI] 1.22-3.22, P<0.01), with history of bladder cancer (OR=2.69, 95% CI 1.71-4.24, P<0.01), receiving nephron-sparing surgery (OR=2.15, 95% CI 1.30-3.57, P<0.01), and cancer occurring in the lower segment of ureter (OR=1.40, 95% CI 1.11-1.78, P<0.01) were significantly related to IVR of UTUC after surgery. These risk factors were also independent risk factors of IVR of UTUC after surgery in the multivariate Cox regression model. Conclusion Aged ≥ 65 years old, bladder cancer history, receiving nephron-sparing surgery and cancer occuring in lower segment of ureter are the independent risk factors of IVR of UTUC after surgery. The UTUC patients with these risk factors should be suggested to receive careful surveillance and regular cystoscopy examination. |
| Key words: upper-tract urothelial carcinoma recurrence urinary bladder neoplasms risk factor |
