本文選題：上尿路尿路上皮癌 + 變異型　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的評估伴隨組織變異型(CVH)對上尿路尿路上皮癌(UTUC)患者行根治術(shù)后的預(yù)后的影響。方法本研究回顧性分析了我院2009年1月-2012年12月期間行腎輸尿管根治性切除+膀胱袖狀切除術(shù)(RNU)的91例UTUC患者的臨床及病理資料,并請病理科醫(yī)師重閱患者的病理切片。比較伴隨CVH的UTUC組與單純UTUC組的腫瘤特異性生存率(CSS)、無復(fù)發(fā)生存率(DFS)、總生存率(OS)差異。研究應(yīng)用Kaplan-Meier曲線及Log-rank檢驗對各危險因素進行單因素分析,將得出的有意義的危險因素應(yīng)用Cox比例風(fēng)險模型進行多因素分析。結(jié)果91例行RNU的UTUC患者中,隨訪中位數(shù)為46個月。重新閱讀病理切片,共有18例(占19.78%)伴隨CVH。其中7人(占38.89%)死亡,9人(占50%)復(fù)發(fā)。與單純UTUC組相比,高級別(P=0.025)的腫瘤更有可能為伴隨CVH的UTUC。評估UTUC患者、伴隨CVH的UTUC組、單純UTUC組行RNU后5年CSS、DFS、OS比例分別約為:71.53%、60.23%、65.58%(P0.05);65.61%、52.46%、58.56%(P0.05);72.94%、59.23%、67.26%(P0.05)。單因素分析得出伴隨CVH與CSS(P=0.005)、DFS(P=0.048)、OS(P=0.047)相關(guān)。多因素分析得出:伴隨CVH是影響UTUC的CSS(HR=0.233,95%CI:0.065-0.842,P=0.026)、OS(HR=0.246,95%CI:0.076-0.793,P=0.019)的獨立危險因素,不是影響UTUC的DFS(HR=0.412,95%CI:0.138-1.224,P=0.110)的獨立危險因素。結(jié)論在行RNU的UTUC患者病理診斷中,約五分之一伴隨CVH。本研究得出伴隨CVH是影響UTUC患者RNU術(shù)后CSS、OS的獨立危險因素,該類患者預(yù)后較單純UTUC差。病理醫(yī)師應(yīng)在UTUC患者病理標(biāo)本中尋找潛在的CVH,并常規(guī)報告,從而指導(dǎo)臨床制定輔助治療方案及隨訪計劃。
[Abstract]:Objective to evaluate the effect of CVH on the prognosis of patients with upper urinary tract urothelial carcinoma (UTUC) after radical resection. Methods the clinical and pathological data of 91 cases of UTUC patients undergoing radical nephrectomy and sleeve resection of the bladder (RNU) during the period of December January 2009 -2012 were retrospectively analyzed. The pathological section of the patients was reviewed. The tumor specific survival rate (CSS), the non recurrent survival rate (DFS) and the total survival rate (OS) were compared with the CVH group UTUC group and the simple UTUC group. The Kaplan-Meier curve and Log-rank test were used to analyze the risk factors by single factor analysis, and the significant risk factors would be applied to the Cox proportional hazard model. Results multifactor analysis was performed in the 91 patients with RNU's UTUC. The median follow-up was 46 months. A total of 18 cases (19.78%) were accompanied by CVH., 7 (38.89%) died and 9 (50%) recurred. Higher level (P=0.025) tumors were more likely to assess UTUC patients with CVH associated UTUC., accompanied by CVH. In group UTUC, the proportion of CSS, DFS and OS in group UTUC only 5 years after RNU was 71.53%, 60.23%, 65.58% (P0.05), 65.61%, 52.46%, 58.56% (P0.05), 72.94%, 59.23%, 67.26% (P0.05). 0.842, P=0.026), independent risk factors of OS (HR=0.246,95%CI:0.076-0.793, P=0.019) are not independent risk factors affecting DFS (HR=0.412,95%CI:0.138-1.224, P=0.110) of UTUC. Conclusion in the pathological diagnosis of UTUC patients in RNU, about 1/5 accompanied by CVH. this study concluded that the accompanying CVH is an independent risk. Factors, the prognosis of this type of patient is less than that of simple UTUC. The pathologist should find the potential CVH in the pathological specimens of UTUC patients, and the routine report should be used to guide the clinical formulation of adjuvant therapy and follow-up plan.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.1

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