Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
Department of Pediatric Surgery, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453100, Henan, China.
BMC Urol. 2019 Apr 18;19(1):24. doi: 10.1186/s12894-019-0457-5.
To investigate the prognostic risk factors and postoperative recurrence of bladder cancer in patients with upper urinary tract urothelial carcinomas (UTUCs).
Data of 439 UTUC patients were retrospectively analyzed. Follow-up and analysis of smoking effects, consumption of traditional Chinese medicine containing aristolochic acid, history of bladder cancer, age, sex, presence or absence of diabetes mellitus (DM), metformin use, tumor characteristics (number, location, stage, grade), and open or laparoscopic surgery on the prognosis of UTUCs were performed. Cox proportional hazard regression analysis was performed to analyze the relationship between various factors and the postoperative survival rate. The survival rate was analyzed using the Kaplan-Meier method. Moreover, logistic regression analysis was performed to analyze the relationship between the above mentioned factors and postoperative recurrence of bladder cancer.
Overall, 439 patients met, including 236 males (53.7%) and 203 females (46.3%), the criteria for the final statistical analysis, and the average age was 66.7 years. The 1-, 3-, and 5-year overall survival rates of 439 UTUC patients were 90.0, 76.4, and 67.7%, respectively. The 5-year survival rates of T1, T2, T3, and T4 patients were 90.2%, 78%, 43.8%, and 18.5%, respectively. Factors influencing the long-term survival rate of UTUC patients were smoking, taking traditional Chinese medicine containing aristolochic acid, history of bladder cancer, age, tumor size, tumor stage, tumor grade, and lymph node metastasis. The risk factors related to postoperative bladder cancer recurrence were advanced tumor stage, high grade tumor, preoperative ureteroscopy, ureteral urothelial carcinoma, no postoperative bladder perfusion chemotherapy and DM without metformin use.
Advanced tumor stage and presence of a high-grade tumor were risk factors for not only poor UTUC prognosis but also BC recurrence. In addition, preoperative ureteroscopy, ureteral urothelial carcinoma and DM without metformin use were high risk factors for BC recurrence, whereas regular postoperative bladder perfusion chemotherapy was a protective factor.
探讨上尿路尿路上皮癌（UTUC）患者的预后危险因素和术后复发情况。
回顾性分析 439 例 UTUC 患者的资料。随访并分析吸烟影响、服用含马兜铃酸的中药、膀胱癌病史、年龄、性别、是否存在糖尿病（DM）、使用二甲双胍、肿瘤特征（数量、位置、分期、分级）以及开放式或腹腔镜手术对上尿路尿路上皮癌预后的影响。采用 Cox 比例风险回归分析分析各因素与术后生存率的关系。采用 Kaplan-Meier 法分析生存率。此外，还进行了 logistic 回归分析，以分析上述因素与膀胱癌术后复发的关系。
共有 439 例患者符合最终统计分析标准，其中男 236 例（53.7%），女 203 例（46.3%），平均年龄为 66.7 岁。439 例 UTUC 患者的 1、3、5 年总生存率分别为 90.0%、76.4%和 67.7%。T1、T2、T3 和 T4 期患者的 5 年生存率分别为 90.2%、78%、43.8%和 18.5%。影响 UTUC 患者长期生存率的因素有吸烟、服用含马兜铃酸的中药、膀胱癌病史、年龄、肿瘤大小、肿瘤分期、肿瘤分级和淋巴结转移。与术后膀胱癌复发相关的危险因素包括肿瘤分期较晚、肿瘤分级较高、术前输尿管镜检查、输尿管尿路上皮癌、术后膀胱灌注化疗及 DM 未使用二甲双胍。
晚期肿瘤分期和高级别肿瘤不仅是 UTUC 预后不良的危险因素，也是膀胱癌复发的危险因素。此外，术前输尿管镜检查、输尿管尿路上皮癌和 DM 未使用二甲双胍是膀胱癌复发的高危因素，而定期术后膀胱灌注化疗是保护因素。
