摘要目的 探讨原发性上尿路移行细胞癌根治术后发生膀胱癌的危险因素及术后发生膀胱癌与患者预后的关系. 方法 回顾性分析115例原发性上尿路肿瘤根治术后的临床病理资料.免疫组织化学检测肿瘤标记物Ki-67和P53蛋白在尿路上皮癌中的表达.结合传统临床病理参数和肿瘤标记物,多因素分析发生膀胱癌的危险因素.比较发生膀胱癌组和未发生膀胱癌组患者的预后情况. 结果 原发性上尿路肿瘤根治术后膀胱癌的发生率为11.3％(13/115),随访7～130个月,平均48.5个月.多因素生存分析发现患病年龄大于65岁(P=0.040),输尿管下段肿瘤(P=0.008)和Ki-67低表达(P=0.041)可作为膀胱癌出现的预测因素.发生膀胱癌组和未发生膀胱癌组平均无疾病进展生存时间分别为(92.1±13.3)个月和(112.8±43.0)个月,两组差异无统计学意义(P＞0.05).发生膀胱肿瘤组和未发生组平均无疾病生存时间为(113.5±4.3)个月和(116.0±5.0)个月,两组差异无统计学意义(P＞0.05). 结论 患者高龄,输尿管下段肿瘤和Ki 67低表达是原发性尿路上皮癌根治术后发生膀胱癌的独立危险因素,根治术后发生膀胱癌与疾病进展和特异性生存无关,但是伴有危险因素的患者仍需密切随访和积极治疗.

abstractsObjective To analysis the risk factors and prognosis of bladder carcinoma currence in patients with transitional-cell carcinoma of primary upper urinary tract after radical operation.Methods The clinical data were retrospectively collected in 115 patients with carcinoma of primary upper tract.The protein expressions of tumor markers Ki-67 and P53 were detected by immunohistochemistry.Combined with traditional cliniopathological factors and molecular markers,the risk factors of bladder carcinoma occurrence were analyzed.Results The incidence of bladder cancer was 11.3％(13/115) and the mean follow-up time was 48.5 months.Age more than 65 years (P=0.040),ureteral tumors (P =0.008) and the lower expression of Ki-67 (P =0.041) were independent predictors for bladder cancer.The survival time of non-progression were(92.1 ± 13.3) and(112.8±4.3) months in bladder tumor group and non-bladder tumor group,but there was no significant difference between the two groups(P＞0.05).The survival time of no disease were(113.5 ± 4.3) and (116.0 ± 5.0) months,respectively (P＞ 0.05).Conclusions Advance age,lower ureteral tumors and down-expression of Ki-67 were independent predictors for bladder tumor recurrence in primary upper tract urothelial carcinomas after nephroureterectomy.There was no relationship between bladder tumor recurrence and oncological outcomes.However,close follow-up and rigorous treatment are essential for patients with high risk factors.