發(fā)布時(shí)間：2018-06-10 11:09

  本文選題：上尿路上皮腫瘤 + UTUC�。� 參考：《山東大學(xué)》2017年碩士論文

【摘要】：研究背景和研究目的上尿路上皮性腫瘤(UTUC)作為一種相對(duì)罕見(jiàn)的泌尿系惡性腫瘤,在尿路上皮性腫瘤中約占5-10%,包括腎盂腫瘤和輸尿管腫瘤,腎盂腫瘤的發(fā)病率約為輸尿管腫瘤的兩倍。約17%的UTUC患者在診斷時(shí)同時(shí)伴有膀胱腫瘤。UTUC發(fā)病年齡的高峰為70-90歲,男女比例約為3:1。由于UTUC侵襲性強(qiáng),患者在接受根治性手術(shù)后的預(yù)后仍難以令人滿意。局部浸潤(rùn)性UTUC患者的五年腫瘤特異性生存率(CSS)約為50%,晚期腫瘤患者的五年腫瘤特異性生存率不足10%。腫瘤的病理分期,腫瘤分級(jí),是否存在淋巴結(jié)轉(zhuǎn)移以及手術(shù)切緣陽(yáng)性與UTUC患者的預(yù)后密切相關(guān)。此外,宿主的系統(tǒng)性炎癥反應(yīng)被認(rèn)為與腫瘤的發(fā)生,發(fā)展有關(guān)。血漿白蛋白水平作為反應(yīng)機(jī)體系統(tǒng)性炎癥反應(yīng)的指標(biāo),已被報(bào)道與腎透明細(xì)胞癌、卵巢癌以及胰腺癌等多種惡性腫瘤的預(yù)后相關(guān)。在UTUC中,血漿白蛋白水平是否對(duì)判斷腫瘤預(yù)后有價(jià)值仍不清楚。本課題的研究目的探索術(shù)前血漿白蛋白水平是否可以影響UTUC患者的生存并作為判斷預(yù)后獨(dú)立的危險(xiǎn)因素。研究方法我們回顧性的收集了于2006年1月至2013年12月間在山東大學(xué)附屬山東省齊魯醫(yī)院泌尿外科接受根治性腎輸尿管切除術(shù)或節(jié)段性切除術(shù)的無(wú)遠(yuǎn)處轉(zhuǎn)移的UTUC患者共180例的病歷資料。排除標(biāo)準(zhǔn)包括:1.無(wú)術(shù)前血漿白蛋白數(shù)據(jù);2.患者存在自身免疫性疾病、其他系統(tǒng)的腫瘤或接受新輔助放化療;3.病理結(jié)果非尿路上皮癌;4.存在遠(yuǎn)處轉(zhuǎn)移;5.無(wú)隨訪信息。11例患者被排除,剩余169例被用于后續(xù)研究。我們利用工作特征曲線(ROC)對(duì)所有患者的術(shù)前血漿白蛋白數(shù)據(jù)進(jìn)行分析確定最佳界點(diǎn)值。為判定臨床病理特征與生存率之間的關(guān)系,分類變量資料采用卡方檢驗(yàn)或Fisher確切分析法進(jìn)行分析,連續(xù)變量資料采用t檢驗(yàn)進(jìn)行分析。雙側(cè)p值小于0.05認(rèn)為有統(tǒng)計(jì)學(xué)意義。研究結(jié)果169例患者中,107例患者為男性,62例患者為女性;年齡最小的患者為36歲,最大的患者為87歲,平均年齡65.7歲;平均隨訪時(shí)間為53.7個(gè)月,腫瘤病理分期為T(mén)a或T1期的有57例,T2-4期的有112例。單因素分析結(jié)果顯示,腫瘤的大小(4cm或者≥4cm),腫瘤分級(jí)(G1-G2或者G3),病理分期(pTa/T1或者pT2-4)和術(shù)前血漿白蛋白水平(≤43.65g/L或者43.65g/L)與患者的總生存率和腫瘤特異性生存率相關(guān),性別、年齡以及吸煙史與UTUC預(yù)后無(wú)統(tǒng)計(jì)學(xué)關(guān)聯(lián)。對(duì)腫瘤大小、分級(jí)、病理分期以及術(shù)前血漿白蛋白水平做多因素分析,結(jié)果顯示腫瘤的大小,分期和術(shù)前血漿白蛋白水平是總生存率和腫瘤特異性生存率的獨(dú)立預(yù)后因素,腫瘤分級(jí)因與其他指標(biāo)的關(guān)聯(lián)被排除。研究結(jié)論綜上所述,術(shù)前血漿白蛋白水平可作為評(píng)價(jià)UTUC患者預(yù)后的獨(dú)立因素。通過(guò)UTUC患者術(shù)前血漿白蛋白水平判斷預(yù)后,可為UTUC的診斷和治療提供新的信息和幫助。
[Abstract]:Background and objective: as a relatively rare malignant tumor of the urinary system, UUTUC accounts for 5-10% of urothelial tumors, including renal pelvis tumors and ureteral tumors. The incidence of pelvic neoplasms is about twice as high as that of ureteral tumors. About 17% of UTUC patients were diagnosed with bladder neoplasms. The peak age of UTUC was 70-90 years old, and the ratio of male and female was about 3: 1. Because of the aggressive nature of UTUC, the prognosis of the patients after radical operation is still unsatisfactory. The 5-year tumor-specific survival rate (CSS) was about 50 in patients with locally invasive UTUC and less than 10 in patients with advanced tumors. The prognosis of patients with UTUC is closely related to the pathological stage, tumor grade, lymph node metastasis and surgical margin positive. In addition, the systemic inflammatory response of the host is thought to be associated with the occurrence and development of the tumor. As an indicator of systemic inflammatory response, plasma albumin level has been reported to be related to the prognosis of renal clear cell carcinoma, ovarian cancer and pancreatic cancer. In UTUC, it remains unclear whether plasma albumin levels are valuable in judging tumor prognosis. Objective to explore whether preoperative plasma albumin level can affect the survival of patients with UTUC and be an independent prognostic risk factor. Methods from January 2006 to December 2013, we retrospectively collected UTUC patients who underwent radical nephreterectomy or segmental nephrectomy in the Department of Urology, Qilu Hospital, Shandong University, from January 2006 to December 2013. The medical records of 180 cases were analyzed. The exclusion criteria include: one. No preoperative plasma albumin data were available. Patients have autoimmune diseases, other systems of cancer or neoadjuvant radiotherapy and chemotherapy. The pathological results of non-urothelial carcinoma were 4. 5%. There is a distant metastasis of 5. No follow-up information was available. 11 patients were excluded and the remaining 169 patients were used in the follow-up study. We analyzed the preoperative plasma albumin data of all patients by using the working characteristic curve (ROC) to determine the best threshold value. In order to determine the relationship between clinicopathological characteristics and survival rate, the data of classified variables were analyzed by chi-square test or Fisher exact analysis, and the data of continuous variables were analyzed by t-test. Bilateral p < 0.05 is considered to have statistical significance. The results showed that 107 of 169 patients were male and 62 were female, the youngest patient was 36 years old, the largest patient was 87 years old, the average age was 65.7 years, and the average follow-up time was 53.7 months. There were 57 cases with Ta or T 1 stage and 112 cases with T 2-4 stage. Univariate analysis showed that tumor size of 4cm or greater than 4cm, tumor grade G1-G2 or G3, pathological stage pTa-P / T1 or pT2-4) and preoperative plasma albumin level (鈮，

本文編號(hào)：2003004