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Purpose: survival of tumor molecular markers of urothelial carcinoma prognosis clinicopathological parameters and prognosis has been confirmed property univariate analysis and Cox regression model multi-factor analysis, filter out the impact of kidney, ureter and bladder cuff excision (Nephroureterectomy, NU) bladder recurrence and progression independent factors, a prognostic score model for risk stratification of patients and so, to provide a reference for clinical prognosis. Method: collect the Second Affiliated Hospital of Tianjin Medical University from 1997 to 2006 using the standard NU surgery treatment of 219 cases of patients with urinary tract transitional cell carcinoma (UUT-TCC) on the clinical and pathological data using immunohistochemical method which were followed up and complete information on 168 patients, paraffin-embedded specimens of tumor markers P53, Ki-67, E-cadherin, FGFR-3 and MVD expression were measured. 2 Log-rank test was used to compare the following factors on the NU postoperative progression-free survival rates (PFS), tumor-related survival (USS) and (bladder) recurrence-free survival (RFS). Analysis of the variables include: age, gender, gross hematuria, tumor location, other side of the approach of ureteral, bladder perfusion, tumor size, number, histological grade, pathological stage, whether the bladder recurrence, and P53, Ki- 67, E-cadherin, FGFR-3's expression and MVD count. 3 single factor analysis of screening variables introduced Cox PH model line multi-factor analysis, using forward stepwise regression screening variables, and finally get NU postoperative disease progression and independent risk factor for bladder recurrence and to establish appropriate risk equation. 4 prognostic scoring model based on Cox regression coefficient and high-risk patients were divided into the risk of progression and risk of bladder recurrence based on ratings in each of the three risk groups threaten low-risk. The life table method each risk group corresponding to 1-year, 3-year, 5-year PFS and RFS as a reference for clinical prognosis. Harrel reasonableness test used to assess the risk equation. Differences between PFS and RFS 5 compares the three risk groups, comparative scoring models and pathological staging accuracy of prognosis, the verification scoring model effect on prognosis. Results: 1168 patients NU 1 year postoperatively, 3-year, 5-year PFS and USS were 96%, 75%, 71% and 88%, 72%, 68%. RFS of 88%, 76% and 63%, respectively. 2 in accordance with the criteria of P53, Ki-67 and FGFR-3 positive patients, the proportion of 64.3%, 40.5% and 49.4%; abnormal E-cadherin expression accounted for 44.0%; the high MVD accounted for 47.6%. E-cadherin, FGFR-3 and MVD expression and pathological stage; P53, Ki-67, E-cadherin, FGFR-3 and MVD expression with pathologic grade. 3 single-factor analysis showed that: NU postoperative progress factors include: (Log-rank test p less than or close to 0.05), tumor size, intravesical instillation, histological grade, pathological stage, P53, Ki-67, E -cadherin, FGFR-3 expression and MVD count; associated with bladder recurrence risk factors include: the pathological grade bladder instillation, whether multiple lower ureteral cancer and Ki-67 expression. 67.3% of bladder recurrence seen in NU 2 years after the operation, in which the left and right side of the UUT-TCC first recurrence of bladder tumor were 79.6% and 81.0% in the ipsilateral ureteral orifice around. High grade high grade UUT-TCC postoperative recurrence of bladder cancer. 4 multi-factor analysis showed that independent factors affecting postoperative PFS and USS: pathological grade, pathological stage, P53 and E-cadherin expression; independent factors affecting bladder recurrence: pathological grade, intravesical instillation multiple tumors and lower ureteral cancer. 5 to establish the of progress risks and bladder recurrence risk prognostic scoring model life table method to get low-risk patients with risk group NU postoperative 1 year, 3-year, 5-year progression and bladder recurrence probability of 0%, 2%, 5 and 6%, 9%, 20%; risk group was 10%, 24%, 29% and 13%, 27%, 45%; high-risk group, 29%, 76%, 80% and 31%, 47% , 75% of each group compared to the differences were significant (p <0.01). Conclusion: The pathological grade, pathological stage, P53 and E-cadherin expression independent factors for to affect NU postoperative progression of. 2 pathological grading, bladder instillation, whether the tumor-prone, whether lower ureteral cancer NU postoperative bladder recurrence risk independent factors, this subject detection of tumor markers in bladder recurrence risk were not related. 3 bladder recurrence peak time for NU after two years, a good site for the ipsilateral ureter around the mouth, bladder recurrence of PFS and USS no effect. Chemotherapy drugs intravesical instillation NU can effectively reduce the risk of bladder recurrence after surgery. 5 integrated multi-influencing factors prognostic scoring model can be stratified according to prognostic risk patients, help to improve the accuracy of the prediction of prognosis in patients with UUT-TCC.
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