探討上泌尿道泌尿上皮癌術後膀胱復發之預測因子

Significant predictors of urinary bladder recurrence following radical nephroureterectomy for upper tract urothelial carcinoma

陳卷書(Chuan-Shu Chen)

指導教授 ： 楊順發

中山醫學大學/醫學院/醫學研究所/博士(2021年)

https://doi.org/10.6834/csmu202100105

摘要

本研究主要探討上泌尿道泌尿上皮癌的病人接受腎臟輸尿管切除手術後發生膀胱復發的危險因子。本篇回溯型研究從西元2001年1月到西元2015年12月在單一醫學中心總共收案550個病人，所有個案皆為上泌尿道泌尿上皮癌接受過腎臟輸尿管切除手術，整體病人的中位數年齡為68歲 (範圍24-93)；從腎臟輸尿管切除術後的中位數追蹤時間為40.3個月(範圍8-191)。本研究主要觀察的重點為是否發生膀胱復發。在本篇研究納入的550名個案之中，共有164名個案發生膀胱復發(佔29.8%)。在這些復發的個案中，有142名個案(佔86.6%)的膀胱復發是發生在術後兩年內。從手術後到膀胱復發的中位數復發時間是8.4個月(範圍3-59.8)。這些上泌尿道泌尿上皮癌的病人在腎臟輸尿管切除手術之後的膀胱復發，經過單變項分析，我們發現“手術邊緣陽性”及“腫瘤多發性”是兩個重要且具意義的預測因子；不過，再次經過多變項分析檢驗之後，僅“腫瘤多發性”這個因子才是唯一一個對於膀胱復發有明顯的預測能力。在上泌尿道泌尿上皮癌接受過腎臟輸尿管切除的個案中，“腫瘤多發性”對於手術後的膀胱復發是一個具意義的危險因子。

關鍵字

膀胱 ； 復發 ； 腎臟輸尿管切除手術 ； 上泌尿道泌尿上皮癌 ； 腫瘤多發性

並列摘要

The purpose of this study was to identify the significant risk factors of urinary bladder recurrence (UBR) after nephroureterectomy (NUx) in patients with upper tract urothelial carcinoma (UTUC). A total of 550 patients diagnosed with UTUC between January 2001 and December 2015 were included in this retrospective study. The median age of our patients was 68 (range 24–93) and the median follow-up time after NUx was 40.3 months (range 8–191). The most important censored point of this study was the first episode of UBR. Of the 550 patients, UBR occurred in 164 patients (29.8%). One hundred and forty-two (86.6%) patients with UBR were identified within two years after NUx for UTUC, with the median time interval between NUx and UBR being 8.4 months (range 3–59.8). Through univariate analysis, the positive surgical margin (p=0.049) and tumor multifocality (p=0.024) were both significant prognostic factors for UBR-free survival after NUx in patients with UTUC. However, only tumor multifocality (p=0.037) remained a significant prognostic factor by multivariate analysis. In conclusion, tumor multifocality is a significant risk factor of UBR after nephroureterectomy in patients with upper tract urothelial carcinoma.

並列關鍵字

urinary bladder ； recurrence ； nephroureterectomy ； upper tract urothelial carcinoma ； tumor multifocality

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