摘要目的：探讨上尿路尿路上皮癌（ UTUC）的流行病学、临床病理特点及预后。方法收集368例于北京大学第三医院行根治术治疗并经病理证实为UTUC的病例，分析其流行病学及临床病理特点。获得随访资料214例，随访1～216个月，平均41个月。结果368例 UTUC 中男性128例，女性240例，男女比为1∶1.9；年龄31～88岁，中位年龄68岁。肿瘤部位包括肾盂148例，输尿管155例，肾盂及输尿管均受累58例，肾盂输尿管移行处7例。14.7％（54／368）的患者有肾移植病史，更容易在65岁之前发生UTUC（P＜0.01），且肿瘤易双侧同时发生（P＜0.01）和呈多灶性分布（P＝0.004）。组织学上低级别101例，低级别伴高级别成分（10％～90％）17例，高级别247例。高级别UTUC多发生于女性患者（P＝0.010），且组织学变异型较多见（P＜0.01）。组织学分级与T分期（P＜0.01）、脉管内瘤栓（P＝0.001）、神经侵犯（P＝0.005）、伴原位癌（P＝0.001）及大片坏死（P＝0.020）呈正相关性。分期上T2-T4肿瘤组织学变异型较多见（P＝0.010）；T分期与肿瘤大小（P＜0.01）、脉管内瘤栓（P＜0.01）、神经侵犯（P＜0.01）及淋巴结转移（P＝0.001）均呈正相关性。本组病例中214例获得完整随访信息，其中存活138例，死亡76例。组织学分级（P＝0.002，P＝0.005）、T分期（P＜0.01，P＜0.01）、脉管内瘤栓（P＝0.001，P＝0.008）、神经侵犯（P＜0.01，P＝0.001）及伴大片坏死（ P＝0.017，P＝0.023）均与患者总生存期和无病生存期呈负相关性，其中T分期（P＜0.01，P＜0.01）及伴大片坏死（P＝0.004，P＝0.014）均为总生存期和无病生存期的独立预后因素，神经侵犯（P＝0.007）及淋巴结转移（P＝0.007）仅为总生存期的独立预后因素。结论 UTUC女性患者多见，肾盂与输尿管发病率基本持平，后者略为多见。有肾移植病史的患者发病年龄较轻，多以复查体检或疼痛发现占位性病变；且肿瘤易双侧和多灶。 UTUC的组织学分级、T分期、脉管内瘤栓、神经侵犯及伴大片坏死均与患者总生存期和无病生存期呈负相关性，其中T分期及伴大片坏死均为总生存期和无病生存期的独立预后因素。

abstractsObjective To evaluate the epidemiology, clinicopathological features and prognosis in upper tract urothelial carcinoma ( UTUC) patients.Methods All archival 368 UTUC cases that underwent radical nephroureterectomy between September 1999 and October 2014 were reviewed, and their clinicopathological features were analyzed.Follow-up time was 1-216 months, with a mean follow-up of 41 month.Results One hundred and twenty-eight male and 240 female patients were included, with a mean age of 68 years ranging from 31 to 88 years.Tumor locations were classified in detail as follows:148 renal pelvic tumors, 155 ureteral tumors, 58 renal pelvic and ureteral tumors, and 7 transitional tumors.Patients with history of renal transplantation (14.7%,54/368) were more likely to develop UTUC before the age of 65 ( P <0.01 ) , with bilateral tract involved ( P <0.01 ) and multifocal distributed ( P =0.004 ).Histological grade was significantly associated with T stage (P<0.01), lympho-vascular involvement (P=0.001), neural invasion (P =0.005), carcinoma in situ (P =0.001) and extensive necrosis (P =0.020), while high-grade UTUC predominantly occurred in female patients (P=0.010) and histological&nbsp;variants ( P<0.01 ).T stage was positively correlated with tumor size ( P <0.01 ) , lympho-vascular involvement ( P <0.01 ) , neural invasion ( P <0.01 ) and lymph node metastasis ( P =0.001 ).Furthermore, among the 214 followed-up cases, 76 died of the disease.Histological grade ( P=0.002, P=0.005), T stage (P<0.01, P<0.01), lympho-vascular involvement (P=0.001, P=0.008), neural invasion (P <0.01, P =0.001) and extensive necrosis (P =0.017, P =0.023) were significantly associated with shorter overall survival and cancer specific survival of UTUC patients, respectively.In multivariable analyses, T stage (P<0.01, P<0.01) and extensive necrosis (P=0.004, P=0.014) were independent predictive factors of both overall survival and cancer specific survival, while neural invasion (P=0.007) and lymph node metastasis (P=0.007) were independent predictors of the overall survival. Conclusions Chinese UTUC reveals its unique epidemiology.UTUC more commonly occurs in women and has a similar incidence between the renal pelvic and ureteral carcinoma.Patients with history of renal transplantation are prone to detect UTUC through physical examination rather than hematuria.Histological grade, T stage, lympho-vascular involvement, neural invasion and extensive necrosis are predictors of survival in UTUC patients, while advanced-stage and extensive necrosis are independent predictors of poor outcome.