伴随病理组织变异型对上尿路尿路上皮癌根治术后预后的影响

发布时间：2018-06-03 15:25

本文选题：上尿路尿路上皮癌 + 变异型　；参考：《青岛大学》2017年硕士论文

【摘要】：目的评估伴随组织变异型(CVH)对上尿路尿路上皮癌(UTUC)患者行根治术后的预后的影响。方法本研究回顾性分析了我院2009年1月-2012年12月期间行肾输尿管根治性切除+膀胱袖状切除术(RNU)的91例UTUC患者的临床及病理资料,并请病理科医师重阅患者的病理切片。比较伴随CVH的UTUC组与单纯UTUC组的肿瘤特异性生存率(CSS)、无复发生存率(DFS)、总生存率(OS)差异。研究应用Kaplan-Meier曲线及Log-rank检验对各危险因素进行单因素分析,将得出的有意义的危险因素应用Cox比例风险模型进行多因素分析。结果91例行RNU的UTUC患者中,随访中位数为46个月。重新阅读病理切片,共有18例(占19.78%)伴随CVH。其中7人(占38.89%)死亡,9人(占50%)复发。与单纯UTUC组相比,高级别(P=0.025)的肿瘤更有可能为伴随CVH的UTUC。评估UTUC患者、伴随CVH的UTUC组、单纯UTUC组行RNU后5年CSS、DFS、OS比例分别约为:71.53%、60.23%、65.58%(P0.05);65.61%、52.46%、58.56%(P0.05);72.94%、59.23%、67.26%(P0.05)。单因素分析得出伴随CVH与CSS(P=0.005)、DFS(P=0.048)、OS(P=0.047)相关。多因素分析得出:伴随CVH是影响UTUC的CSS(HR=0.233,95%CI:0.065-0.842,P=0.026)、OS(HR=0.246,95%CI:0.076-0.793,P=0.019)的独立危险因素,不是影响UTUC的DFS(HR=0.412,95%CI:0.138-1.224,P=0.110)的独立危险因素。结论在行RNU的UTUC患者病理诊断中,约五分之一伴随CVH。本研究得出伴随CVH是影响UTUC患者RNU术后CSS、OS的独立危险因素,该类患者预后较单纯UTUC差。病理医师应在UTUC患者病理标本中寻找潜在的CVH,并常规报告,从而指导临床制定辅助治疗方案及随访计划。
[Abstract]:Objective to evaluate the effect of CVH on the prognosis of patients with upper urinary tract urothelial carcinoma (UTUC) after radical resection. Methods the clinical and pathological data of 91 cases of UTUC patients undergoing radical nephrectomy and sleeve resection of the bladder (RNU) during the period of December January 2009 -2012 were retrospectively analyzed. The pathological section of the patients was reviewed. The tumor specific survival rate (CSS), the non recurrent survival rate (DFS) and the total survival rate (OS) were compared with the CVH group UTUC group and the simple UTUC group. The Kaplan-Meier curve and Log-rank test were used to analyze the risk factors by single factor analysis, and the significant risk factors would be applied to the Cox proportional hazard model. Results multifactor analysis was performed in the 91 patients with RNU's UTUC. The median follow-up was 46 months. A total of 18 cases (19.78%) were accompanied by CVH., 7 (38.89%) died and 9 (50%) recurred. Higher level (P=0.025) tumors were more likely to assess UTUC patients with CVH associated UTUC., accompanied by CVH. In group UTUC, the proportion of CSS, DFS and OS in group UTUC only 5 years after RNU was 71.53%, 60.23%, 65.58% (P0.05), 65.61%, 52.46%, 58.56% (P0.05), 72.94%, 59.23%, 67.26% (P0.05). 0.842, P=0.026), independent risk factors of OS (HR=0.246,95%CI:0.076-0.793, P=0.019) are not independent risk factors affecting DFS (HR=0.412,95%CI:0.138-1.224, P=0.110) of UTUC. Conclusion in the pathological diagnosis of UTUC patients in RNU, about 1/5 accompanied by CVH. this study concluded that the accompanying CVH is an independent risk. Factors, the prognosis of this type of patient is less than that of simple UTUC. The pathologist should find the potential CVH in the pathological specimens of UTUC patients, and the routine report should be used to guide the clinical formulation of adjuvant therapy and follow-up plan.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.1

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