多发性上尿路上皮癌的临床病理特点及预后分析

目的:探讨多发性上尿路上皮癌(UTUC)的临床和病理特点及预后。方法:回顾性分析230例UTUC患者的临床和病理资料,比较多发性UTUC与单发性UTUC组间的病理TN分期、Grade分级、合并膀胱内肿瘤有无差异(χ2检验)以及两组间术后生存时间是否相同(生存分析采用Kaplan-Meier生存曲线及Wilcoxon检验)。结果:38例患者术后病理诊断为多发性UTUC,与单发性UTUC相比,其预示着更高的病理分级(P=0.031)、分期(P<0.01)、淋巴结转移率(P=0.023)及合并膀胱肿瘤的比例(P=0.002)。术后随访3～302个月,平均随访30个月,发现死亡66例,其中多发性UTUC组死亡13例,术后3年总体生存率为40.0%(P=0.036)。结论:多发性UTUC具有更强的生物学侵袭特性,预后更差,治疗策略应选择根治性肾输尿管切除术,术后需要更严密随访。

A clinicopathological study of multifocal urothelial carcinomas in upper urinary tract

Objective:To analyze the clinicopathological features and prognosis of multifocal upper-tract urothelial carcinoma.Methods:Using a two-institutional,retrospective database,we identified 230 patients with UTUC between 1996 and 2011.Tumor location was categorized as renal pelvis,ureter,or multifocal.We compared the pathological factors of stage,grade,regional lymph nodes and the rates of synchronous bladder tumors between multifocal UTUC and single lesion disease(χ2 test).The postoperative survival were analyzed as well(using the Kaplan-Meier method and compared among groups with the Wilcoxon test).Results:38 patients of UTUCs are diagnosed as multifocal tumors post operation.Compared with single lesion disease,multifocal tumors were more likely to be associated with high-grade disease(P=0.031),high stage(P<0.01),lymph node metastasis(P=0.023)and high proportion of synchronous bladder tumors.The patients were followed up for 30 months(3-302 months).There were 66 patients dead observed.Among these,multifocal tumors were found 13 cases.3-year postoperative over-all survival rate is 40%.There were significant differences of postoperative survival between the two groups(P=0.036).Conclusions:Tumor multifocality is characterized by biologically aggressive.Multifocal UTUC had a worse prognosis than single lesion disease.Multifocal patients with UTUC may need treated with radical nephroureterectomy and closer follow-up.