Division of Nephrology, Department of Internal Medicine, Chia-yi Christian Hospital, Chia-yi, Taiwan.
Am J Med Sci. 2011 Aug;342(2):148-52. doi: 10.1097/MAJ.0b013e318223e800.
The goal of this study was to compare the clinical and pathological features of urothelial carcinoma (UC) identified in patients with end-stage renal disease (ESRD) and advanced-stage chronic kidney disease (CKD). The predictive value of CKD on patient mortality in these UC patients was also analyzed.
From January 1997 to December 2008, 141 patients with pathologically proven UC with stage 4/5 CKD (predialysis) and patients with ESRD receiving long-term dialysis were identified under an institutional review board approval protocol. The medical records and survival outcome of these patients were reviewed.
A total of 141 UC patients with renal diseases (n = 97, 68.8%, of stage 4/5 CKD; n = 44, 31.2%, at dialysis) were enrolled. Patients with stage 4/5 CKD were significantly older, male gender, less anemic and more likely to have higher prevalence of diabetes mellitus (P < 0.05). We noticed a more significant increase in the frequency of high-stage UC (24.7% and 6.8%) and a larger tumor size (50.5% and 27.3%) in patients with stage 4/5 CKD, compared with patients with ESRD (P < 0.05). Old age at the time of dialysis initiation in patients with ESRD [hazard ratio (HR) = 1.121, P = 0.039], male gender (HR = 6.822, P = 0.016) and high-stage tumors (HR = 5.012, P = 0.008) in patients with stage 4/5 CKD were independent predictors of mortality from UC.
Patients with stage 4/5 CKD had more aggressive histological UC patterns than did patients with ESRD.
本研究旨在比较终末期肾病（ESRD）和晚期慢性肾脏病（CKD）患者中发现的尿路上皮癌（UC）的临床和病理特征。还分析了 CKD 对这些 UC 患者患者死亡率的预测价值。
根据机构审查委员会批准的方案，我们在 1997 年 1 月至 2008 年 12 月期间，共确定了 141 例经病理证实的伴有 4/5 期 CKD（透析前）和接受长期透析的 ESRD 患者的 UC 患者。我们回顾了这些患者的病历和生存结果。
共纳入 141 例患有肾脏疾病的 UC 患者（97 例，占 4/5 期 CKD 的 68.8%；44 例，占透析的 31.2%）。4/5 期 CKD 患者年龄明显较大，男性居多，贫血程度较轻，糖尿病患病率较高（P<0.05）。我们注意到，与 ESRD 患者相比，4/5 期 CKD 患者中高分期 UC 的频率显著增加（24.7%和 6.8%），肿瘤体积更大（50.5%和 27.3%）（P<0.05）。ESRD 患者透析开始时年龄较大（HR=1.121，P=0.039）、男性（HR=6.822，P=0.016）和 4/5 期 CKD 患者中高分期肿瘤（HR=5.012，P=0.008）是 UC 死亡的独立预测因素。
与 ESRD 患者相比，4/5 期 CKD 患者的 UC 组织学表现更为侵袭性。
