根治性肾输尿管切除术治疗后合并马兜铃酸肾病的上尿路尿路上皮癌的临床病理特征和预后。
Clinicopathologic characteristics and prognosis of upper tract urothelial carcinoma complicated with aristolochic acid nephropathy after radical nephroureterectomy.
机构信息
Department of clinical laboratory, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China.
Department of Blood Transfusion, The Second Hospital of Jinlin University, Changchun, 131000, People's Republic of China.
出版信息
BMC Complement Med Ther. 2020 Jun 3;20(1):166. doi: 10.1186/s12906-020-2861-5.
BACKGROUND
The purpose of this study was to identify the clinicopathologic characteristics and prognosis of upper tract urothelial carcinoma (UTUC) patients complicated with aristolochic acid nephropathy(AAN) after radical nephroureterectomy (RNU).
METHODS
The clinical data of 42 UTUC patients with AAN (AAN group) and 238 UTUC patients without AAN (Non-AAN group) were retrospectively reviewed. All patients received a RNU with excision of bladder cuff. Demographic and clinical data, including preoperative indexes, intraoperative indexes and surgical outcomes were compared.
RESULTS
There were no significant differences in age, tumor location, surgery approach, tumor pathologic grade, stage, the mean operative time and estimated blood loss between the two groups (all p > 0.05). There were more female patients in the AAN group (p < 0.001), and 57.1% were high grade tumors. The AAN group showed a higher complications rate (p = 0.003). The median follow-up time was 43.2 months. The AAN group showed a worse estimated 5-year overall survival rate (35.1% vs. 63.0%, p = 0.014), however, no significant difference was found between the two groups with regard to disease specific survival (63.5% vs. 81.5%, p = 0.091). Multivariate binary logistic regression analysis showed that AAN was an independent factor related with overall and disease specific survival. 38.9% of all patients experienced any types of recurrence, and the estimated 5-year recurrence-free survival rate was lower in the AAN group (37.1% vs. 63.7%, p = 0.001). In the comparison of subgroups stratified by recurrence type, the AAN group had a higher intravesical (p = 0.030) and contralateral recurrence rate (p = 0.040).
CONCLUSION
UTUC with AAN occurred more frequently in female patients who were more likely to develop high-grade tumors. However, these patients showed a worse overall survival and a lower recurrence-free survival rate than the other patients. AA-related UTUC might be associate with an increased risk of intravesical and contralateral recurrence after RUN.
背景
本研究旨在探讨根治性肾输尿管切除术（RNU）后合并马兜铃酸肾病（AAN）的上尿路尿路上皮癌（UTUC）患者的临床病理特征和预后。
方法
回顾性分析 42 例合并 AAN 的 UTUC 患者（AAN 组）和 238 例无 AAN 的 UTUC 患者（非 AAN 组）的临床资料。所有患者均接受 RNU 加膀胱袖状切除。比较两组患者的一般资料、术前指标、术中指标及手术结果。
结果
两组患者在年龄、肿瘤位置、手术方式、肿瘤病理分级、分期、手术时间及术中出血量等方面比较，差异均无统计学意义（均 P>0.05）。AAN 组女性患者比例明显高于非 AAN 组（P<0.001），且肿瘤分级多为高级别（57.1%）。AAN 组并发症发生率高于非 AAN 组（P=0.003）。中位随访时间为 43.2 个月。AAN 组患者的 5 年总生存率（35.1%比 63.0%，P=0.014）及疾病特异性生存率（63.5%比 81.5%，P=0.091）均较非 AAN 组差，但差异均无统计学意义。多因素二元逻辑回归分析显示，AAN 是影响总生存及疾病特异性生存的独立因素。所有患者中有 38.9%出现各种类型的复发，AAN 组患者的 5 年无复发生存率（37.1%比 63.7%，P=0.001）低于非 AAN 组。在根据复发类型进行的亚组比较中，AAN 组患者的膀胱内复发率（P=0.030）和对侧复发率（P=0.040）均较高。
结论
AAN 合并 UTUC 更常见于女性患者，且这些患者更易发生高级别肿瘤。然而，与其他患者相比，这些患者的总生存率和无复发生存率均较差。AAN 相关的 UTUC 可能与 RNU 后膀胱内和对侧复发的风险增加有关。
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