摘要
目的 探讨应用吉西他滨联合顺铂（GC）方案辅助化疗的上尿路尿路上皮癌（UTUC）患者预后的相关影响因素.方法 回顾性分析2013年1月-2018年7月首都医科大学附属北京友谊医院收治的80例UTUC患者的临床和随访资料.所有患者均行UTUC根治性手术,所有患者均按照GC方案化疗：第1、8、15天,吉西他滨800 mg/m2,30min内静脉滴注;第2天顺铂70 mg/m2,避光2h静脉滴注;28 d为1个周期.化疗前后给予抑酸、水化、止吐等辅助治疗.患者均完成1～5个周期,平均2个周期.以患者的年龄、性别、有无合并积水、原发肿瘤部位、肿瘤分期及分级、有无淋巴血管浸润、有无肿瘤复发、有无单纯淋巴结转移、有无脏器转移、化疗周期、总生存期等作为观察指标.对患者的总生存期进行单因素分析,筛选出与预后相关的临床变量,再应用COX比例风险模型进行多因素预后分析,确定独立影响因素.结果 80例UTUC患者电话随访2～72个月,中位随访时间为27个月.16例（20％）患者死于UTUC复发或转移,64例（80％）患者存活,1年累积生存率为78.26％ （18/23）,2年累积生存率为54.18％ （9/13 ×78.26％）,3年累积生存率为39.41％ （8/11 ×54.18％）,4年累积生存率为31.53％ （12/15 ×39.41％）,5年累积生存率为28.66％（10/11 ×31.53％）.单因素分析表明,合并肾积水（P =0.023）、淋巴血管浸润（LVI）（P=0.001）、肿瘤TNM分期（P=0.002）、肿瘤复发（P=0.008）、单纯淋巴结转移（P=0.005）、脏器转移（P＜0.001）与生存率有关.COX模型多因素分析表明,与接受GC方案化疗的UTUC患者生存期相关的独立危险因素为合并肾积水（HR =4.355,95％ CI：1.232～15.390,P=0.022）、LVI（HR=0.133,95％ CI：0.035～0.509,P=0.003）、TNM分期（HR =0.099,95％ CI：0.010～0.929,P=0.043）.结论 有无合并肾积水、LVI、肿瘤TNM分期是影响GC方案辅助化疗的UTUC患者预后的独立影响因素.
Objective To investigate the prognostic factors of patients with upper urinary tract urothelial carcinoma （UTUC） treated with gemcitabine plus cisplatin （GC）.Methods The clinical and follow-up data of 80 patients with UTUC admitted to Beijing Friendship Hospital,Capital Medical University from January 2013 to July 2018 were retrospectively analyzed.All patients underwent UTUC radical surgery.All patients were treated with GC regimen：1,8,and 15 days,Gemcitabine 800 mg/m2,intravenous infusion over 30 min;day 2 Cisplatin 70 mg/m2,protected from light 2 h intravenous drip;28 d for 1 cycle.Adjuvant treatments such as acid suppression,hydration,and antiemetic were given before and after chemotherapy.Patients completed 1 to 5 cycles with an average of 2 cycles.The patient＇s age,gender,presence or absence of water,primary tumor site,tumor stage and grade,lymphatic vascular infiltration,tumor recurrence,lymph node metastasis,organ metastasis,chemotherapy cycle,total Survival,etc.are used as indicators ofobservation.Univariate analysis of the patient＇s overall survival,screening for clinical variables associated with prognosis,and then using the COX proportional hazards model for multivariate prognostic analysis to determine independent influencing factors.Results Eighty patients with UTUC were followed up for 2 to 72 months with a median follow-up of 27 months.Sixteen patients （20%） died of UTUC recurrence or metastasis,and 64 （80%） patients survived.The 1-year cumulative survival rate was 78.26% （18/23）,and the 2-year cumulative survival rate was 54.18% （9/13 ×78.26%）,the 3-year cumulative survival rate was 39.41% （8/1 1 × 54.18%）,the 4-year cumulative survival rate was 31.53% （12/15 × 39.41%）,and the 5-year cumulative survival rate was 28.66% （10/11 × 31.53%）.Univariate analysis showed combined hydronephrosis （P =0.023）,lymphatic vessel infiltration （LVI） （P =0.001）,tumor TNM stage （P =0.002）,tumor recurrence （P =0.008）,simple lymph node metastasis （P =0.005）,organ metastasis （P 〈 0.001） was related to survival rate.COX model multivariate analysis showed that the independent risk factors associated with survival of patients with UTUC receiving chemotherapy with GC regimen were hydronephrosis （HR =4.355,95%CI：1.232-15.390,P=0.022）,LVI （HR =0.133,95% CI：0.035-0.509,P=0.003）,TNM stage （HR=0.099,95%CI：0.010-0.929,P=0.043）.Conclusion The presence or absence of hydronephrosis,LVI,and tumor TNM staging are independent factors influencing the prognosis of patients with UTUC who have adjuvant chemotherapy.
作者
肖荆
阮极盟
王苗苗
王翔宇
韩天栋
张彩祥
陈美元
佟欣
朱一辰
田野
Xiao Jing;Ruan Jimeng;Wang Miaomiao;Wang Xiangyu;Han Tiandong;Zhang Caixiang;Chen Meiyuan;Tong Xin;Zhu Yichen;Tian Ye(Department of Urology,Bering Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《国际外科学杂志》
2018年第9期591-595,共5页
International Journal of Surgery
基金
首都医科大学附属北京友谊医院科研启动基金（yyqdkt2017-2）
关键词
上尿路尿路上皮癌
吉西他滨
生存分析
顺铂
预后
Urinary tract urothelial carcinoma
Gemcitabine
Survival analysis
Cisplatin
Prognosis
