| ObjectiveRetrosppectively analyzing the clinical data of patients with renal pelvic cancer from 2012 to 2017 in our hospital,to investigate the clinical features,diagnosis treatment and prognosia of renal pelvis cancer to improve the level of clinical diagnosis and treatment.Materials and methodsA retrosppective analysis from February 2012 to February 2017 in the first affliated hospital of zhengzhou university 110 cases of renal pelvic cancer who had undergone surgical treatment and pathologically diagnosed,and were followed up.Paraments examined include clinical features,diagnosis,postoperative pathological character,treatment and prognosis.ResultsOf the 110 patients,73 cases were male,37 cases were femal,male to female ratio was 1.97:1.The onset age is 32-92 years,the average onset age is(64.2±1.5)year.The clinical mannifestations of gross hematuria in 86 cases,with a duration of 3 days to five years.Besides,they is 2 case with microscopic hematuria,10 cases with low back or abdomen pain,5 cases with kindey stone or hydronephrosis,2 cases with fever,5 cases were found in routine physical examination.The lessions were located in 59 cases on left side of the kidney,51 cases on the right side.All patients included in the study,the positive rate of urinary ultrasonography is 81%(85/105),CT/CTU is 91%(100/110),URS is 83.3%(65/78),urinary exfoliative cytology(11/40),urine ultrasounnd examination is 27.5(11/40).31 patients with hypertension and 19 patients with diabetes.110 cases underwent surgery and the operation was smooth.102 cases were diagnosed as renal pelvic cancer,99 cases underwent radical resection of renal pelvis,and 3 cases received nephron-sparing surgery for renal pelvic cancer.7 cases were diagnosed with renal cell carcinoma before operation,Six patients underwent ureteral stump and bladder sleeve resection after radical nephrectomy,and one underwent renal ureter and bladder sleeve resection after partial nephrectomy.One case was diagnosed as a stone with severe hydronephrosis,so no functional nephrectomy,second stage ureteral stump and bladder sleeve resection.Postoperative pathology confirmed 99 cases of urothelial carcinoma,4 cases of urothelial carcinoma with squamous cell carcinoma differentiation,2 cases of urothelial carcinoma with adenocarcinoma differentiation,2 cases of urothelial carcinoma semi-squamous cell carcinoma adenocarcinoma differentiation,1 cases of squamous cell carcinoma,2 cases of sarcomatoid carcinoma.Pathological specimen: tumor diameter(3.90±0.27)cm,Range 0cm-16 cm,the cut surface is mostly gray,grayish yellow,hard and crisp.110 patients in this group were followed up for 8-84 months,.Average follow-up time is 34 months.Tumor staging according to 2014 UICC TNM staging system was pTa with 10 patients,pTis with 1 patient,pT1 with 13 patient,pT2 with 42 patient,pT3 with36 patient,pT34 with 8 patient.The 2-year,3-year,and 5-year survival rates of renal pelvic cancer were 88.2%,76%,and 52.2%,respectively.The 2-,3-,and 5-year survival rates of Ta-T2 patients were 95.4%,89.3%,and 69.3%,respectively.The 2-,3-,and 5-year survival rates of patients with T3-4 were 81.8% and 57.4%,and 28.7%,respectively.There were no significant differences in gender,age,lesion diameter,tumor location and surgical procedure between Ta-T2 and T3-T4 patients(P>0.0.5).The overall survival rate of the two groups was statistically significant(χ2=14.986,P<0.05).Postoperative pathological grade according to WHO2004 urothelial carcinoma histological grading standard,eighty-one patients with pathologically graded urothelial carcinoma were screened from 110 pathological data:low-grade malignant potential urothelial papilloma in 7 cases,accounting for 8.6% of the sample,25 cases of low-grade urothelial carcinoma,accounting for 33.9%,49 cases of high-grade urothelial carcinoma,accounting for 60.5 %.The 3-year and 5-year survival rates of low-grade urothelial carcinoma were 90.4%、62.8%,respectively,and the 3-year and 5-year survival rates of high-grade urothelial carcinoma were 74.6%、29.5%,respectively.There were no significant differences in gender,age,tumor diameter,tumor location,surgical procedure,TNM staging,etc.between the two groups of low-grade urothelial carcinoma and high-grade urothelial carcinoma(p>0.05),The overall survival rate of the two groups was statistically significant(P<0.05).ConclusionsClinically,renal pelvic cancer is common in pT2 and pT3 stages,and it is easy to have early lymph node or(and)distant metastasis,which may be related to lower 5-year survival rate and poor prognosis.pT3,pT4 stage renal pelvic cancer due to tumor infiltration of renal parenchyma,imaging findings are atypical,difficult to distinguish with renal cancer and other renal parenchymal diseases before surgery,easy to cause misdiagnosis.There is a higher incidence of bladder tumor after pyelocarcinoma surgery.Postoperative follow-up should be routinely performed cystoscopy,and prophylactic bladder infusion chemotherapy is recommended for patients with high-grade tumors.Pathological staging and cell grading of renal pelvic cancer are important factors affecting the survival rate of patients. |
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