【摘要】 目的:探讨上尿路尿路上皮癌(UTUC)患者术后尿路外复发影响因素及危险分层价值。方法:回顾性分析2010年1月-2014年12月收治135例行根治手术治疗UTUC患者临床资料,采用单因素和多因素法分析术后尿路外复发影响因素,同时根据危险度分层比较随访无局部复发生存率和无远处转移生存率。结果:(1)无蒂状肿瘤、多病灶、输尿管癌、淋巴脉管侵犯、病理分期≥T3期、eGFR<60 mL·min-1·1.73 m-2)及Fib≥3.2 g/L患者无局部复发生存率均显著低于其他患者(P<0.05);肿瘤分级G3级、无蒂状肿瘤、淋巴脉管侵犯、中重度肾盂积水及中性粒-淋巴细胞比值>2.0患者无远处转移生存率均显著低于其他患者(P<0.05);(2)多因素分析结果提示,输尿管癌、淋巴脉管侵犯、病理分期≥T3期及Fib≥3.2 g/L均是患者无局部复发生存率独立危险因素(P<0.05);无蒂状肿瘤、淋巴脉管侵犯及中性粒-淋巴细胞比值>2.0均是患者无远处转移生存率独立危险因素(P<0.05);(3)低危组随访1、3、5年无局部复发生存率显著高于中危组和高危组(P<0.05);低危组随访1、3、5年无远处转移生存率显著高于中危组和高危组(P<0.05)。结论:输尿管癌、淋巴脉管侵犯、病理分期≥T3期及Fib≥3.2g/L与UTUC患者术后局部复发密切相关;而无蒂状肿瘤、淋巴脉管侵犯及中性粒-淋巴细胞比值>2.0则可增加术后远处转移风险;根据相关独立危险因素进行危险度分层能够有效预测患者临床预后。更多还原

【Abstract】 Objective:To investigate the influencing factors of postoperative extra-urinary tract recurrence and risk stratification in patients with upper tract urothelial carcinoma(UTUC).Methods:Clinical data of 135 patients with UTUC were retrospectively chosen in the period from January 2010 to December 2014. Univariate and multifactorial methods were used to analyze the influencing factors of postoperative extra-urinary tract recurrence,and the local recurrence-free survival(IRFS)rate and distant metastasis-free survival(dMFS)rate were compared according to risk stratification.Results:(1) The IRFS rate in patients with non-pedicle tumor,multiple lesions,ureteral cancer,lymphatic vascular invasion,pathological stage ≥ T3,eGFR < 60 mL·min-1·1.73 m-2)and Fib ≥ 3.2 g/L was significantly lower than other patients(P < 0.05). The dMFS in patients with tumor grade for G3,non-pedicle tumor,lymphatic vascular invasion,moderate and severe hydronephrosis,and neutro-lymphocyte ratio > 2.0 was significantly lower than other patients(P < 0.05).(2) The multivariate analysis indicated that ureteral cancer,lymphatic vascular invasion,pathological stage ≥ T3 and Fib ≥ 3.2 g/L were all independent risk factors for IRFS rate(P < 0.05).The non-pedicle tumor,lymphatic vascular invasion and neutro-lymphocyte ratio > 2.0 were all independent risk factors for dMFS rate(P < 0.05).(3) The 1-,3-and 5-year IRFS rate during the follow-up period in the low-risk group was significantly higher than that in medium-risk group and high-risk group(P < 0.05). The 1-,3-and 5-year dMFS rate during the follow-up period in low-risk group was significantly higher than that in medium-risk group and highrisk group(P < 0.05).Conclusion:Ureteral cancer,lymphatic vascular invasion,pathological stage ≥ T3 and Fib ≥ 3.2 g/L were closely related to postoperative local recurrence of patients with UTUC and the non-pedicle tumor,lymphatic vascular invasion and neutro-lymphocyte ratio > 2.0 increased the risk of postoperative distant metastasis. Risk stratification based on relevant independent risk factors can effectively predict the clinical prognosis of patients.更多还原