摘要目的 探讨肾盂输尿管癌手术区域淋巴结清扫的临床意义. 方法 回顾性分析1990年1月至2011年1月收治的143例肾盂输尿管癌手术患者资料.男91例,女52例.年龄33～86岁,平均64岁.术中行区域淋巴结清扫67例,未清扫76例.术后TNM分期:清扫组T1、T2、T3、T4期分别为6、9、44、8例,未清扫组分别为21、14、36、5例.病理分级:清扫组G1、G2、G3级分别为3、25、39例,未清扫组为2、38、36例.分析区域淋巴结清扫对生存率和肿瘤复发、转移的影响. 结果 清扫组平均随访56.2个月,未清扫组42.7个月.两组T3～T4期患者的肿瘤复发或进展率分别为19.0％、49.0％(x2=9.16,P＜0.01),远处转移率分别为9.6％、31.7％(x2=7.17,P＜0.01),组间比较差异有统计学意义.清扫组T1、T2、T3、T4期患者淋巴结转移率分别为0、11.0％、32.0％、78.0％(x2=6.01,P＜0.05),G1、G2、G3级淋巴结转移率分别为0、16.0％、46.0％(x2=7.51,P＜0.01).两组肿瘤相关性累积生存率分别为77.7％和57.1％(P=0.061),两组T3～T4期患者相关性累积生存率分别为76.2％与29.9％ (P=0.017).多因素分析表明,肿瘤分级(P=0.0008)、分期(P=0.0013)及淋巴结清扫(P=0.0087)为预后相关因素. 结论 肾盂输尿管癌手术时行肿瘤区域淋巴结清扫术能更准确地进行肿瘤分期,将显著改善W3 ～ T4期患者的生存.

abstractsObjective To evaluate the role of regional lymphadenectomy on the survival of patients with upper urinary tract urothelial carcinoma.Methods The data of 143 patients with transitional cell carcinoma of the upper urinary tract (91 males and 52 females; mean age,64 years) with radical nephroureterectomy from January 1990 to January 2011 were analyzed retrospectively.Lymphadenectomy was performed in 67 patients (study group),and was not performed in 76 patients (control group).TNM staging showed stage T1,T2,T3,T4 tumor in 6,9,44,8 cases of study group and 21,14,36,5 cases in control group,respectively.The effect of lymphadenectomy on the survival was retrospectively analyzed.Results Medium follow-up were 56.2 and 42.7 months in 2 groups,respectively.The recurrence rate(19.0％ and 49.0％,x2=9.16,P＜0.01) and the distant metastatic rate (9.6％ and 31.7％,x2=7.17,P＜0.01) were significantly different in 2 groups when the T stage was pT3 or higher.The metastatic rates of dissected lymph nodes of stage T1,T2,T3,T4 were 0,11.0％,32.0％ and 78.0％ (x2=6.01,P＜0.05),respectively; the metastatic rates of dissected lymph nodes of grade G1,G2,G3 were 0,16.0％,46.0％ (x2 =7.51,P＜0.01),respectively.The disease specific survival (77.7％ and 57.1％,P=0.061) did not significantly differ between the 2 groups.However,patient survival rates (76.2％ and 29.9％,P=0.017) were significantly different in 2 groups when the T stage was pT3 or higher.Multivariate analysis showed that lymphadenectomy (P =0.0087) was a significant grognostic factor for caner specific survival as well as T stage (P =0.0013) and tumor grade (P=0.0008).Conclusions It is suggested that the regional lymph nodes should be resected necessarily.The lymphadenectomy may significantly improve the prognosis of upper urinary tract urothelial carcinoma,especially for patients with advanced disease.