Division of Nephrology, Department of Internal Medicine, Chia-yi Christian Hospital, Chia-yi, Taiwan.
World J Urol. 2011 Aug;29(4):511-6. doi: 10.1007/s00345-011-0682-3. Epub 2011 May 19.
Taiwan is a highly endemic area for urothelial carcinoma (UC) and chronic kidney disease (CKD). We evaluate the gender effect on the relationship between renal outcome and clinical characteristics of CKD patients with UC.
The clinical and pathologic records of 404 patients were retrospectively analyzed. We calculated glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) equation, and staged CKD status according to K/DOQI guideline.
The female group had a significantly higher proportion (67.6% vs 29.0%, P < 0.001) of upper urinary tract urothelial carcinoma (UUT-UC). Pathologically, the frequency of high T stage UC (32.4% and 19.1%; P = 0.003), high-grade UC (89.4% and 75.6%; P = 0.001), and larger UC (51.4% and 37.8%; P = 0.009) in the female patients were significantly higher, when compared with the male group. Male gender, diabetes, anemia, poor preoperative renal function, UUT-UC, and low-grade tumor were independent risk factors of poor renal outcome by multivariate analysis in these UC patients. Diabetes was a risk factor of poor renal outcome in male UUT-UC patients, but not in the female patients (P = 0.009).
Female gender had a more aggressive histological urothelial carcinoma pattern than male patients did, but paradoxically had a more favorable renal outcome.
台湾是尿路上皮癌（UC）和慢性肾脏病（CKD）的高度流行区。我们评估了性别对患有 UC 的 CKD 患者的肾脏结局与临床特征之间关系的影响。
回顾性分析了 404 例患者的临床和病理记录。我们使用肾脏病饮食改良试验（MDRD）方程计算肾小球滤过率（GFR），并根据 K/DOQI 指南分期 CKD 状态。
女性组上尿路尿路上皮癌（UUT-UC）的比例明显较高（67.6%比 29.0%，P<0.001）。病理上，女性患者中高 T 期 UC（32.4%比 19.1%，P=0.003）、高级别 UC（89.4%比 75.6%，P=0.001）和 UC 较大（51.4%比 37.8%，P=0.009）的频率明显较高。多因素分析显示，男性、糖尿病、贫血、术前肾功能差、UUT-UC 和低级别肿瘤是这些 UC 患者肾脏结局不良的独立危险因素。糖尿病是男性 UUT-UC 患者肾脏结局不良的危险因素，但不是女性患者的危险因素（P=0.009）。
女性的组织学尿路上皮癌模式比男性更具侵袭性，但奇怪的是，女性的肾脏结局更好。
