尿路上皮癌治疗中保留器官预后评估

发布时间：2018-03-19 17:47

本文选题：尿路上皮癌　切入点：输尿管部分切除术　出处：《上海交通大学》2015年博士论文　论文类型：学位论文

【摘要】：目的评估输尿管部分切除术(SU)与肾输尿管全长切除术(RNU)对于治疗Ta、T1、T2期输尿管尿路上皮癌的预后差异。评估肿瘤位于输尿管口是否为影响不同手术方式预后结果的因素。材料与方法自2004年12月至2014年6月我中心共有81例罹患局部非进展性(p Ta、p T1、p T2)输尿管上皮癌的患者接受SU或RNU手术治疗。我们随访并回顾了这些病例,利用Kaplan-Meier生存分析来评估两种手术的肿瘤学预后差异是否显著。我们利用Cox回归分析评估了肿瘤分期、分级、病灶位置、术前肾积水及膀胱癌史是否为影响肿瘤预后的因素。结果RNU组与SU组的平均随访时间为别为55.3个月和50.9个月。两组的总体5年肿瘤特异性生存率(CSS)为72.7%,其中RNU组5年CSS为72.3%,SU组为73.8%,两者之间差异不具有统计学意义(p=0.763)。SU组11名患者出现同侧上尿路复发,局部复发率为32.4%,RNU组未发现同侧局部复发。两种术后的膀胱无复发生存率(b RFS)、无转移生存率(MFS)、肿瘤特异性生存率(CSS)以及总生存率(OS)均无统计学差异(p=0.596,p=0.740,p=0.809,p=0.553)。远端输尿管肿瘤具有更好的预后结果。按病灶位置分组后(输尿管中段肿瘤、输尿管远端肿瘤),两种术式的肿瘤学预后同样未见显著差异(p0.05)。结论我们的研究表明对于T2及以下分期的上尿路上皮癌,SU与RNU在肿瘤学预后方面并无显著差异。输尿管远端肿瘤具有更好的手术预后,但差异并非由不同手术方式造成。目的评估膀胱部分切除术(PC)与根治性全膀胱切除术(RC)对于治疗浸润性膀胱癌(MIBC)的预后差异。材料与方法自2004年11月至2014年8月我中心共252例罹患肌层浸润性膀胱癌(MIBC)的患者接受PC或RC手术治疗。其中PC组共178例(T2期130例,T3期39例,T4期9例);RC组共54例(T2期11例,T3期31例,T4期12例)。我们利用SPSS软件绘制Kaplan-Meier生存曲线,来分析评估两种手术的预后差异是否显著。同时我们建立Cox回归模型来分析影响肿瘤预后的因素。结果随访时间7-97个月(54.3±13.2)个月。总体5年特异性生存率为67.3%。PC组与RC组的5年CSS分别为69.2%与57.7%,两组间存在显著差异(P=0.017)。但由于组间差异较大,结果存在选择性偏倚。多因素分析结果显示手术方式(PC或RC)不是影响MIBC术后生存及PC术后复发的独立因素。肿瘤分期晚、膀胱癌史、肿瘤浸润性生长及脉管侵犯是MIBC术后生存的独立预后因素。肿瘤分期晚、膀胱癌史、肿瘤浸润性生长及肿瘤数量3个是PC术后复发的独立预后因素。结论我们的研究表明采用何种手术方式(PC或RC)并不是影响MIBC手术预后的独立因素。
[Abstract]:Objective to evaluate the difference of prognosis between partial ureterectomy (SUU) and full-length nephroureterectomy (RNUN) in the treatment of ureteral urothelial carcinoma (UUEC) at stage Taht1 and T2. To evaluate whether the presence of tumor at the ureteral orifice affects the prognosis of different surgical procedures. Materials and methods from December 2004 to June 2014, a total of 81 patients with locally nonprogressive carcinoma of ureteral epithelium were treated with Su or RNU. We followed up and reviewed these cases. Kaplan-Meier survival analysis was used to evaluate the difference of oncology prognosis between the two operations. Cox regression analysis was used to evaluate the tumor staging, grading, location of the tumor. Results the mean follow-up time between RNU group and Su group was 55.3 months and 50.9 months. The overall 5-year tumor specific survival rate was 72.7 in RNU group. In 5 years CSS was 72.3% and 73.8% in SU group. There was no significant difference between the two groups in 11 patients with ipsilateral upper urinary tract recurrence. No local recurrence was found in the RNU group, and there was no significant difference between the two groups in the survival rate of bladder recurrence (RFSs), MFSs, tumor specific survival rate (CSS) and overall survival rate (OS). There was no significant difference between the two groups in the distal ureteral swelling (P < 0. 596P 0. 809p 0. 553). The tumor has a better prognosis. After grouping according to the location of the lesion (middle ureteral tumor, There was also no significant difference in the prognosis between the two surgical procedures for distal ureteral neoplasms. Conclusion our study shows that there is no significant difference between Su and RNU in the oncology prognosis of upper urinary epithelial carcinoma with stages T 2 and below. [WT5 "HZ] [WT5" BZ] [WT5BZ] there is no significant difference in the oncology prognosis between Su and RNU. The distal urethral tumor has a better prognosis. But the difference was not caused by different surgical methods. Objective to evaluate the difference of prognosis between partial cystectomy and radical total cystectomy in the treatment of invasive bladder cancer. Materials and methods from November 2004 to August 2014. A total of 252 patients with myometrial invasive bladder cancer were treated with PC or RC surgery in our center. In PC group, there were 178 cases with T 2 stage 130 cases with T 3 stage and 39 cases with T 3 stage C 9 cases with T 4 stage. There were 54 cases with T 2 stage T 3 stage and 31 cases with T 3 stage T 4 and 12 cases with stage 4. Using SPSS software to draw Kaplan-Meier survival curve, At the same time, we established Cox regression model to analyze the factors influencing the prognosis of tumor. Results the follow-up time was 7-97 months, 54.3 卤13.2 months. The overall 5-year specific survival rate was 67.3%. The 5-year CSS of RC group was 69.2% and 57.7, respectively. There was a significant difference between the two groups. Results selective bias was found. Multivariate analysis showed that PC or RC were not independent factors for survival and recurrence after MIBC. Invasive growth and vascular invasion are independent prognostic factors for survival after MIBC. The invasive growth and the number of tumor were independent prognostic factors for the recurrence of MIBC. Conclusion our study shows that the choice of surgical procedure (PC or RCC) is not an independent factor for the prognosis of MIBC surgery.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R737.1

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