目的:探讨影响原发性输尿管癌预后及其术后继发膀胱癌的危险因素.方法:回顾性分析58例2010年6月至2017年9月于重庆医科大学附属第一医院行手术治疗,病理诊断为输尿管癌患者的临床资料,对可能影响输尿管癌预后的7个临床及病理因素进行单因素和多因素Cox模型分析,对可能影响输尿管癌术后继发膀胱癌的5个临床及病理因素进行单因素和多因素Cox模型分析.结果:单因素分析表明:临床分期(x2=16.441,P=0.000)、组织学分级(x2=6.941,P=0.008)、术后是否化疗(x2=4.934,P=0.026)与输尿管癌预后显著相关.性别(x2=0.414,P=0.520)、年龄(x2=2.013,P=0.156)、肿瘤是否多发(x2=0.029,P=0.865)、手术方式(x2=0.243,P=0.622)与预后无关.浸润深度(x2=5.314,P=0.021)、术后膀胱灌注(x2=3.919,P=0.048)、组织学分级(x2=7.025,P=0.008)、手术方式(x2=6.565,P=0.010)与输尿管癌术后继发膀胱癌显著相关.肿瘤是否多发(x2=1.291,P=0.256)与输尿管癌术后继发膀胱癌无关.多因素分析表明:临床分期(RR =6.037,95％CI=1.708 ～21.333,P=0.005)及组织学分级(RR=10.032,95％CI=1.161～86.695,P=0.036)是影响输尿管癌预后的显著因素,高级别组织学分级(RR=8.942,95％CI=1.175～68.056,P=0.034)及非根治手术(RR=3.819,95％CI=1.424～10.244,P=0.008)是输尿管癌术后继发膀胱癌的危险因素(RR＞1).结论:输尿管癌的临床分期及组织学分级是决定预后的显著影响因素;组织学分级及手术方式是影响输尿管癌术后继发膀胱癌的显著独立危险因素.

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