Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
J Urol. 2010 May;183(5):1732-7. doi: 10.1016/j.juro.2010.01.028. Epub 2010 Mar 17.
Preoperative hydronephrosis may be associated with a worse outcome in patients who undergo radical cystectomy for invasive bladder cancer. We characterized the prognostic significance of hydronephrosis, and its relationship to cancer stage and outcome. We also evaluated concordance between the side of identifiable hydronephrosis and concomitant pelvic lymph node metastasis.
We analyzed information from our prospectively collected database of patients who underwent radical cystectomy for bladder cancer from January 2001 to December 2007. We examined the relationship between hydronephrosis and clinical variables as well as survival outcome. Hydronephrosis was diagnosed intraoperatively or by radiographic imaging within 3 months of radical cystectomy.
Of 753 patients 244 (32%) were diagnosed with hydronephrosis. Logistic regression modeling revealed that hydronephrosis was an independent predictor of extravesical disease (OR 2.01, 95% CI 1.37 to 2.96, p <0.001) and node positive disease (OR 1.94, 95% CI 1.29 to 2.91, p = 0.001). Of patients with hydronephrosis 88 (36.1%) had concomitant node positive disease and 74 (30.3%) had node positive disease on the same side as hydronephrosis. Thus, hydronephrosis predicted the side of nodal involvement in 74 of 88 patients (84%) with identifiable hydronephrosis and node positive disease.
Hydronephrosis is an independent predictor of advanced bladder cancer stage, and it predicts extravesical disease and node positive disease. Thus, it could prove useful to select patients for neoadjuvant chemotherapy before surgery. The strong correlation between hydronephrosis side and nodal metastasis may have implications for surgical staging and approach.
术前肾积水可能与接受根治性膀胱切除术治疗浸润性膀胱癌的患者的预后较差有关。我们对肾积水的预后意义及其与癌症分期和结果的关系进行了特征描述。我们还评估了可识别的肾积水侧与同期盆腔淋巴结转移之间的一致性。
我们分析了 2001 年 1 月至 2007 年 12 月期间我们前瞻性收集的接受根治性膀胱切除术治疗膀胱癌患者的数据库信息。我们检查了肾积水与临床变量以及生存结果之间的关系。肾积水是在根治性膀胱切除术前或术后 3 个月内通过影像学检查诊断的。
在 753 例患者中，有 244 例（32%）被诊断为肾积水。Logistic 回归模型显示，肾积水是尿路上皮外疾病（OR 2.01，95%CI 1.37 至 2.96，p <0.001）和淋巴结阳性疾病（OR 1.94，95%CI 1.29 至 2.91，p = 0.001）的独立预测因素。在肾积水患者中，有 88 例（36.1%）同时患有淋巴结阳性疾病，有 74 例（30.3%）同侧肾积水合并淋巴结阳性疾病。因此，在 88 例可识别的肾积水和淋巴结阳性疾病患者中，肾积水预测了 74 例患者（84%）的淋巴结受累侧。
肾积水是膀胱癌晚期的独立预测因素，它预测尿路上皮外疾病和淋巴结阳性疾病。因此，它可能有助于在手术前选择接受新辅助化疗的患者。肾积水侧与淋巴结转移之间的强相关性可能对手术分期和方法具有重要意义。
