上尿路上皮癌根治性切除术后血糖控制不良者预后影响因素分析

王斌　黎鼎荣　陈存波　林玉龙

【摘要】 目的：探究上尿路上皮癌根治性切除术血糖控制不良者预后的影响因素。方法：选择2015年6月-2018年6月于本院接受根治性切除术的60例上尿路上皮癌患者为研究对象。按照其是否为高血糖患者将其区分为高血糖组（23例）与非高血糖组（37例），比较两组患者临床特征、不同时间局部复发、远处转移情况，而后按照患者随访结局区分为良好组（34例）与不良组（26例），采用单因素与多因素Cox比例风险模型分析影响患者预后的独立风险因素。结果：与非高血糖组相比，高血糖组患者中空腹HDL-C<1.04 mmol/L、并发代谢综合征、临床分期T3～4、淋巴结轉移占比明显更高，差异均有统计学意义（P<0.05）。高血糖组术后2年生存率明显高于非高血糖组（P<0.05）。单因素分析发现，空腹TG≥1.7 mmol/L、空腹HDL-C<1.04 mmol/L、高血糖、临床分期T3～4、淋巴结转移与上尿路上皮癌根治性切除术后预后不良有明显的关系（P<0.05）。经多因素Cox分析发现，高血糖、淋巴结转移均是上尿路上皮癌根治性切除术后预后不良的独立危险因素（P<0.05）。结论：血糖控制不良是上尿路上皮癌根治性切除术后患者预后不良的独立危险因素，对此类患者应注意加强临床监控，以预防不良事件发生，改善患者预后。

【关键词】 上尿路上皮癌 根治性切除术 血糖控制不良 预后不良 相关性

[Abstract] Objective： To investigate the prognostic factors of patients with poor glycemic control after radical resection of upper urothelial carcinoma. Method： A total of 60 patients with upper urothelial carcinoma who underwent radical resection in our hospital from June 2015 to June 2018 were selected as the research subjects. They were divided into hyperglycemic group （23 cases） and non-hyperglycemic group （37 cases） according to whether they were hyperglycemic patients or not. The clinical characteristics， local recurrence and distant metastasis of two groups were compared， and the patients were divided into good group （34 cases） and bad group （26 cases） according to the follow-up outcome. Univariate and multivariate Cox proportional risk model were used to analyze the independent risk factors affecting the prognosis of patients. Result： Compared with non-hyperglycemia group， the proportion of fasting HDL-C<1.04 mmol/L， complicated metabolic syndrome， clinical stage T3-4 and lymph node metastasis in hyperglycemia group were significantly higher， with statistical significance （P<0.05）. The 2-year survival rate in hyperglycemia group was significantly higher than that in non-hyperglycemia group （P<0.05）. Single factor analysis showed that fasting TG≥1.7 mmol/L， fasting HDL-C<1.04 mmol/L， hyperglycemia， clinical stage T3-4， lymph node metastasis were significantly associated with poor prognosis after radical resection of upper urothelial carcinoma （P<0.05）. Multivariate Cox analysis showed that hyperglycemia and lymph node metastasis were independent risk factors for poor prognosis after radical resection of upper urothelial carcinoma （P<0.05）. Conclusion： Poor glycemic control is an independent risk factor for poor prognosis in patients with upper urothelial carcinoma after radical resection. Therefore， attention should be paid to strengthening clinical monitoring for such patients to prevent adverse events and improve the prognosis of patients.

[Key words] Upper urothelial carcinoma Radical resection Poor glycemic control Poor prognosis Correlation

First-authors address： The Second Affiliated Hospital of Guangdong Medical University， Zhanjiang 524003， China

doi：10.3969/j.issn.1674-4985.2021.09.011

上尿路上皮癌是一种起源于肾盂或输尿管的尿路上皮恶性肿瘤，此类癌症较为罕见，西方人群中上尿路上皮癌的发病率仅为（1.88～2.06）/10万人，约占全部尿路上皮癌总数的5%～10%。上尿路上皮癌中有25%位于输尿管，有75%位于肾盂肾盏系统，此类癌症具有类似于膀胱尿路上皮癌的特性，呈多中心生长性，而且其单纯病灶及其周围尿路上皮实施切除术后残余的肾盂或输尿管组织具有一定的复发可能，因而临床上多选择根治性切除术应对此类癌症，肾输尿管全切除+膀胱袖状切除已经成为上尿路上皮癌标准治疗方案[1-2]。临床实践发现，上尿路上皮癌具有较强的肿瘤侵袭性，与膀胱癌相比，上尿路上皮癌中的非器官局限性肿瘤和中肌层浸润性肿瘤占比更高，即使实施了根治性切除术，仍有部分高肿瘤分期的患者局部复发、远处转移和死亡率较高，分析其原因可能与上尿路上皮癌呈现多中心生长有关[3-4]。……