孤立肾上尿路尿路上皮癌61例临床诊疗分析

苏晓鸿; 方冬; 张雷; 熊耕砚; 郝瀚; 赵广智; 杨昆霖; 李学松; 周利群

doi:10.13201/j.issn.1001-1420.2016.12.008

孤立肾上尿路尿路上皮癌61例临床诊疗分析

- 北京大学第一医院泌尿外科, 北京大学泌尿外科研究所, 国家泌尿、男性生殖系肿瘤研究中心(北京, 100034)

详细信息

通讯作者: 李学松,E-mail:pineneedle@sina.com; 周利群,E-mail:zhoulqmail@sina.com

中图分类号: R737.1

收稿日期: 2016-09-19

Treatment strategies for upper tract urothelial carcinoma
of the solitary kidney: clinical analysis of 61 cases

- Department of Urology, Peking University First Hospital, Institute of Urology of Peking University, National Cancer Research Center of the Male Reproductive System, Beijing, 100034, China

More Information

Corresponding authors: LI Xuesong ; ZHOU Liqun

Received Date: 19 September 2016

摘要

摘要: 目的:探讨孤立肾上尿路尿路上皮癌(UTUC)的临床特征和合理治疗方案。方法:回顾性分析北京大学第一医院2000年3月~2012年3月诊治的61例继发性孤立肾UTUC患者。其中共29例患者接受肾输尿管全长切除术(RNU),其余32例患者接受保留肾单位术式(NSS)。根据肾功能分为A、B、C组(分别为eGFR≥60 ml/min、15 ml/min≤eGFR＜60 ml/min及eGFR＜15 ml/min),A、B组主要采用NSS术式,C组主要采用RNU术式,分析术前影响手术方式决策的因素,以及不同肾功能水平的孤立肾UTUC患者的预后。结果:61例患者术后恢复良好,其中年龄大(P=0.002)、肿瘤直径小(P=0.013)、未接受肾移植(P=0.007)、肾功能较好(P=0.002)的患者倾向于接受NSS,两种手术方式的总体生存率、肿瘤特异性生存率及复发率的差异无统计学意义;NSS组中仅3例需要术后透析治疗。A组患者中肿瘤复发率为47%,其中3例因肿瘤死亡,4例曾接受肾移植;B组肿瘤复发率为35.2%,5例因肿瘤原因死亡,1例曾经接受肾移植;C组肿瘤复发率为70.5%,6例因肿瘤原因死亡,术后均接受透析治疗,1例曾经接受肾移植。三组复发率、生存率差异无统计学意义。结论:对于孤立肾UTUC患者,应根据肿瘤特征及肾功能情况,选择合适的手术方式;保留肾功能的治疗方法是一种可选择的治疗方法。
- 上尿路尿路上皮癌 /
- 孤立肾 /
- 保留肾单位手术 /
- 根治性肾输尿管全长切除术 /
- 肾功能
Abstract: Objective: To explore the treatment strategies for patients with upper tract urothelial carcinoma (UTUC) of the solitary functioning kidney.Method: We retrospectively analyzed 61 UTUC patients with solitary functioning kidney treated from March 2000 to March 2012. Radical nephroureterectomy (RNU) or nephron-sparing surgery (NSS) was carried out. Based on preoperative renal function, patients were categorized into three groups: group A (eGFR≥60 ml/min), group B (15 ml/min≤eGFR＜60 ml/min), group C (eGFR＜15 ml/min).Result: NSS group was associated with older age (P=0.002), smaller tumor size (P=0.013), without kidney transplantation (P=0.007) and better renal function (P=0.002). There was no significant difference in five-year cancer-specific survival (CSS), overall survival (OS) and recurrence-free survival (RFS) between the two groups. Only three patients needed to receive hemodialysis after operation in NSS group. The intravesical recurrence (IVR) rate was 47% in group A. Three patients died of tumor and four patients had received kidney transplantation. In group B, the IVR rate was 35.2%. Five patients died of tumor and one patient had received kidney transplantation. In group C, 70.5% patients experienced tumor recurrence and six patients died of tumor during the follow-up period. One patient had received kidney transplantation and the other patients needed dialysis in group C after operation. Nodifference was observed in five-year-CSS, OS and RFS among these three groups.Conclusion: Clinicopathological characteristics are important in clinical decision for UTUC patients of the solitary functioning kidney and conservative management could be considered in selective cases.
- UTUC /
- solitary functioning kidney /
- NSS /
- RNU /
- renal function

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