原发肿瘤部位对上尿路上皮癌患者生存的影响及相关预后列线图模型的开发与验证

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Effects of tumor location on the prognosis of upper tract urothelial carcinoma and development and validation of a prognostic nomogram

WANG Zewei LI Hailong LI Gang GAO Zhimin WEN Rumin1

ABSTRACT：Objective To investigate the prognostic value of tumor location in patients with upper tract urothelial carcinoma （UTUC） treated with radical nephroureterectomy （RNU）， and to develop and validate a nomogram model for predicting the overall survival （OS）.Methods UTUC patients undergoing RUN at our hospital during Jan.2010 and Dec.2022 were retrospectively collected， 70% of whom were included in the training group and 30% in the validation group.According to the tumor location， patients were divided into renal pelvis tumor （RPT） group and ureteral tumor （UT） group.The differences in clinicopathological features and prognosis were analyzed.Based on multivariate Cox results， a nomogram model for predicting OS was developed and validated.Results A total of 366 patients （196 RPT and 170 UT） were included in this study.There were statistically significantly differences in urine cytology （P=0.001）， hydronephrosis （P＜0.001）， history of bladder tumor （P=0.021）， pathological T stage （P＜0.001） and histological structure （P=0.037） between the two groups.Multivariate Cox results showed that patients with UT had a worse prognosis （HR=2.00， 95%CI：1.22-3.27， P=0.006）.Factors of the nomogram for predicting OS included age， tumor location， lymphovascular invasion and pathological T stage.The model showed good discrimination and calibration， and performed well in internal verification.Conclusion Compared with RPT，UT has a worse prognosis and the fat around the tumor should be surgically removed more thoroughly to avoid micro-residual.We successfully coustructed a nomogram model that can be used to predict the OS of UTUC patients after RNU surgery.

KEY WORDS：tumor location;upper tract urothelial carcinoma;renal pelvis tumor;ureteral tumor;radical nephroureterectomy；overall survival；nomogram model

摘要：目的 本文旨在探讨原发肿瘤部位对接受根治性肾输尿管切除术（RNU）治疗的上尿路上皮癌（UTUC）患者预后的影响，并开发和验证预测患者术后总生存期（OS）的列线图模型。（剩余9969字）