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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。
Objective: To investigate the clinical and pathological features and prognosis of multiple upper urothelial carcinoma (UTUC). Methods: The clinical and pathological data of 230 patients with UTUC were retrospectively analyzed. The pathological TN staging, Grade grade, the presence or absence of intravesical tumor (χ2 test), and the clinical outcomes between two groups Survival time after the same (survival analysis using Kaplan-Meier survival curve and Wilcoxon test). Results: Thirty-eight patients were diagnosed as multiple UTUC after surgery. Compared with UTUC alone, they were significantly higher in pathological grade (P = 0.031), stage (P <0.01) and lymph node metastasis ) And the proportion of bladder cancer (P = 0.002). The patients were followed up for 3 to 302 months. The average follow-up was 30 months. 66 patients were found dead, of which 13 died in multiple UTUC patients. The 3-year overall survival rate was 40.0% (P = 0.036). CONCLUSIONS: Multiple UTUCs are more invasive in nature and have a poorer prognosis. Radical ureteropexy should be used as the treatment strategy. More rigorous follow-up is needed.