上尿路尿路上皮癌术后出现膀胱复发的危险因素分析

Risk Factors for Intravesical Recurrence after the Surgery of Upper Tract Urothelial Carcinoma

摘要: 目的：探讨上尿路尿路上皮癌(UTUC)患者行根治术后出现膀胱复发的危险因素。方法：收集2015年1月份到2016年12月份在青岛大学附属医院行患侧肾输尿管全长切除术加膀胱袖套状切除术的总共127例UTUC患者的临床资料，分析患者的基线数据、术后病理结果、随访数据等资料，采用卡方检验及logistics回归分析UTUC患者行根治术后出现膀胱复发的危险因素。结果：本研究中，在127例行UTUC根治术的患者中，共28例出现了膀胱复发，复发率为22.0% (28/127)，其中67.9% (19/28)的患者膀胱初次复发出现在术后2年内。患者的年龄、性别、肿瘤的侧别、位置、直径以及术后病理的分期和分级这7项因素的差异无统计学意义(P > 0.05)。而术前进行输尿管镜检、合并膀胱癌病史的患者术后出现膀胱复发的差异有统计学意义(P < 0.05)，视为膀胱复发的危险因素。将上述危险因素纳入logistics回归分析，发现其均为UTUC根治术后出现膀胱复发的独立危险因素。结论：术前行输尿管镜检查、合并膀胱癌病史是UTUC根治术后出现膀胱复发的独立危险因素。临床医师应着重关注存在上述危险因素的UTUC术后患者，做好定期随访。

Abstract: Objective: To investigate the risk factors for intravesical recurrence in patients after the surgery of upper tract urothelial carcinomas (UTUCs). Methods: Clinical data of 127 UTUC patients were collected who underwent full-length nephroureter plus bladder sleeve resection in Affiliated Hospital of Qingdao University during Jan. 2015 to Dec. 2016. The baseline data, postoperative pathological results and follow-up data were analyzed. Chi-square test and logistic regression were used to analyze the risk factors of intravesical recurrence in patients with UTUC after the surgery. Result: In this study, 28 cases of 127 patients were diagnosed intravesical recurrence after radical operation of UTUC, the recurrence rate was 22.0% (28/127), of which 67.9% (19/28) patients had intravesical recurrence within 2 years after operation. There was no significant difference in the incidence of intravesical recurrence among different gender, age, tumor location and size, pathological stage and tumor side (P > 0.05). There was a significant difference in intravesical recurrence between patients undergoing ureteroscopy before the surgery and a history of bladder cancer before operation (P < 0.05), which was regarded as a risk factor for intravesical recurrence. Logistic regression analysis showed that the above risk factors were independent risk factors for intravesical recurrence after radical operation of UTUC. Conclusion: Ureteroscopy before the surgery and history of bladder cancer are independent risk factors for intravesical recurrence after UTUC radical resection. Clinicians should pay more attention to the patients with the above risk factors after UTUC, and make regular follow-up.