Faculty of Medicine, Tottori University, Yonago, Japan.
Int Urol Nephrol. 2013 Feb;45(1):99-106. doi: 10.1007/s11255-012-0347-1. Epub 2012 Dec 11.
To evaluate the clinical significance of preoperative biomarkers such as laboratory data, Eastern Cooperative Oncology Group Performance Status (ECOG PS) and clinicopathological factors in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma.
Between 1995 and 2011, a total of 99 patients treated at our institution for upper urinary tract urothelial carcinoma were enrolled in this study. The prognostic significance of various preoperative data and clinicopathological factors were analyzed. Univariate and multivariate analyses were performed using the Kaplan-Meier method with the log-rank test and a Cox proportional hazards regression model.
Median patient age was 73 years (range 44-86 years), and the median follow-up period after radical nephroureterectomy was 37.9 months (range 6.6-171.4 months). The 5-year intravesical recurrence-free survival and cancer-specific survival estimates were 47.1 and 70.0 %, respectively. On multivariate analysis, concomitant bladder carcinoma was an independent predictor of intravesical recurrence (hazard ratio 3.689; P = 0.002), and infiltration (hazard ratio 14.842; P = 0.002), preoperative serum creatinine level (hazard ratio 9.992; P = 0.005), preoperative serum hemoglobin level (hazard ratio 6.370; P = 0.018) and ECOG PS (hazard ratio 4.326; P = 0.037) were associated with worse cancer-specific survival. This study is limited by biases associated with its retrospective design.
This study indicates that not only clinicopathological factors, but also preoperative biomarkers, such as serum creatinine and hemoglobin levels and ECOG PS, predict a poor survival in patients with upper urinary tract urothelial carcinoma.
评估术前生物标志物（如实验室数据、东部肿瘤协作组体能状态评分[ECOG PS]）和临床病理因素在上尿路尿路上皮癌患者行根治性肾输尿管切除术的临床意义。
1995 年至 2011 年，共有 99 例在我院接受上尿路尿路上皮癌治疗的患者纳入本研究。分析了各种术前数据和临床病理因素的预后意义。采用 Kaplan-Meier 方法和对数秩检验以及 Cox 比例风险回归模型进行单因素和多因素分析。
患者中位年龄为 73 岁（范围 44-86 岁），根治性肾输尿管切除术后中位随访时间为 37.9 个月（范围 6.6-171.4 个月）。5 年膀胱内无复发生存率和癌症特异性生存率分别为 47.1%和 70.0%。多因素分析显示，同时患有膀胱癌是膀胱内复发的独立预测因素（风险比 3.689；P = 0.002），浸润（风险比 14.842；P = 0.002）、术前血清肌酐水平（风险比 9.992；P = 0.005）、术前血清血红蛋白水平（风险比 6.370；P = 0.018）和 ECOG PS（风险比 4.326；P = 0.037）与较差的癌症特异性生存相关。本研究受到回顾性设计偏倚的限制。
本研究表明，在上尿路尿路上皮癌患者中，不仅临床病理因素，而且术前生物标志物（如血清肌酐和血红蛋白水平以及 ECOG PS）也可以预测不良的生存结果。
