术前血浆白蛋白水平对上尿路上皮性肿瘤预后作用的研究

发布时间：2018-06-10 11:09

  本文选题：上尿路上皮肿瘤 + UTUC　； 参考：《山东大学》2017年硕士论文

【摘要】：研究背景和研究目的上尿路上皮性肿瘤(UTUC)作为一种相对罕见的泌尿系恶性肿瘤,在尿路上皮性肿瘤中约占5-10%,包括肾盂肿瘤和输尿管肿瘤,肾盂肿瘤的发病率约为输尿管肿瘤的两倍。约17%的UTUC患者在诊断时同时伴有膀胱肿瘤。UTUC发病年龄的高峰为70-90岁,男女比例约为3:1。由于UTUC侵袭性强,患者在接受根治性手术后的预后仍难以令人满意。局部浸润性UTUC患者的五年肿瘤特异性生存率(CSS)约为50%,晚期肿瘤患者的五年肿瘤特异性生存率不足10%。肿瘤的病理分期,肿瘤分级,是否存在淋巴结转移以及手术切缘阳性与UTUC患者的预后密切相关。此外,宿主的系统性炎症反应被认为与肿瘤的发生,发展有关。血浆白蛋白水平作为反应机体系统性炎症反应的指标,已被报道与肾透明细胞癌、卵巢癌以及胰腺癌等多种恶性肿瘤的预后相关。在UTUC中,血浆白蛋白水平是否对判断肿瘤预后有价值仍不清楚。本课题的研究目的探索术前血浆白蛋白水平是否可以影响UTUC患者的生存并作为判断预后独立的危险因素。研究方法我们回顾性的收集了于2006年1月至2013年12月间在山东大学附属山东省齐鲁医院泌尿外科接受根治性肾输尿管切除术或节段性切除术的无远处转移的UTUC患者共180例的病历资料。排除标准包括:1.无术前血浆白蛋白数据;2.患者存在自身免疫性疾病、其他系统的肿瘤或接受新辅助放化疗;3.病理结果非尿路上皮癌;4.存在远处转移;5.无随访信息。11例患者被排除,剩余169例被用于后续研究。我们利用工作特征曲线(ROC)对所有患者的术前血浆白蛋白数据进行分析确定最佳界点值。为判定临床病理特征与生存率之间的关系,分类变量资料采用卡方检验或Fisher确切分析法进行分析,连续变量资料采用t检验进行分析。双侧p值小于0.05认为有统计学意义。研究结果169例患者中,107例患者为男性,62例患者为女性;年龄最小的患者为36岁,最大的患者为87岁,平均年龄65.7岁;平均随访时间为53.7个月,肿瘤病理分期为Ta或T1期的有57例,T2-4期的有112例。单因素分析结果显示,肿瘤的大小(4cm或者≥4cm),肿瘤分级(G1-G2或者G3),病理分期(pTa/T1或者pT2-4)和术前血浆白蛋白水平(≤43.65g/L或者43.65g/L)与患者的总生存率和肿瘤特异性生存率相关,性别、年龄以及吸烟史与UTUC预后无统计学关联。对肿瘤大小、分级、病理分期以及术前血浆白蛋白水平做多因素分析,结果显示肿瘤的大小,分期和术前血浆白蛋白水平是总生存率和肿瘤特异性生存率的独立预后因素,肿瘤分级因与其他指标的关联被排除。研究结论综上所述,术前血浆白蛋白水平可作为评价UTUC患者预后的独立因素。通过UTUC患者术前血浆白蛋白水平判断预后,可为UTUC的诊断和治疗提供新的信息和帮助。
[Abstract]:Background and objective: as a relatively rare malignant tumor of the urinary system, UUTUC accounts for 5-10% of urothelial tumors, including renal pelvis tumors and ureteral tumors. The incidence of pelvic neoplasms is about twice as high as that of ureteral tumors. About 17% of UTUC patients were diagnosed with bladder neoplasms. The peak age of UTUC was 70-90 years old, and the ratio of male and female was about 3: 1. Because of the aggressive nature of UTUC, the prognosis of the patients after radical operation is still unsatisfactory. The 5-year tumor-specific survival rate (CSS) was about 50 in patients with locally invasive UTUC and less than 10 in patients with advanced tumors. The prognosis of patients with UTUC is closely related to the pathological stage, tumor grade, lymph node metastasis and surgical margin positive. In addition, the systemic inflammatory response of the host is thought to be associated with the occurrence and development of the tumor. As an indicator of systemic inflammatory response, plasma albumin level has been reported to be related to the prognosis of renal clear cell carcinoma, ovarian cancer and pancreatic cancer. In UTUC, it remains unclear whether plasma albumin levels are valuable in judging tumor prognosis. Objective to explore whether preoperative plasma albumin level can affect the survival of patients with UTUC and be an independent prognostic risk factor. Methods from January 2006 to December 2013, we retrospectively collected UTUC patients who underwent radical nephreterectomy or segmental nephrectomy in the Department of Urology, Qilu Hospital, Shandong University, from January 2006 to December 2013. The medical records of 180 cases were analyzed. The exclusion criteria include: one. No preoperative plasma albumin data were available. Patients have autoimmune diseases, other systems of cancer or neoadjuvant radiotherapy and chemotherapy. The pathological results of non-urothelial carcinoma were 4. 5%. There is a distant metastasis of 5. No follow-up information was available. 11 patients were excluded and the remaining 169 patients were used in the follow-up study. We analyzed the preoperative plasma albumin data of all patients by using the working characteristic curve (ROC) to determine the best threshold value. In order to determine the relationship between clinicopathological characteristics and survival rate, the data of classified variables were analyzed by chi-square test or Fisher exact analysis, and the data of continuous variables were analyzed by t-test. Bilateral p < 0.05 is considered to have statistical significance. The results showed that 107 of 169 patients were male and 62 were female, the youngest patient was 36 years old, the largest patient was 87 years old, the average age was 65.7 years, and the average follow-up time was 53.7 months. There were 57 cases with Ta or T 1 stage and 112 cases with T 2-4 stage. Univariate analysis showed that tumor size of 4cm or greater than 4cm, tumor grade G1-G2 or G3, pathological stage pTa-P / T1 or pT2-4) and preoperative plasma albumin level (鈮，

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