Sekita Nobuyuki, Nishikawa Rika, Fujimura Masaaki, Takeuchi Nobuyoshi, Ogino Hiroko, Shibata Naoki, Omura Sachiko, Mikami Kazuo
The Department of Urology, Chibaken Saiseikai Narashino Hospital.
The Department of Urology, Graduate School of Medicine, Chiba University.
Hinyokika Kiyo. 2014 May;60(5):215-9.
Pre-chemotherapeutic factors to assess the prognosis of patients with advanced urothelial carcinoma have not yet been completely established. The immune response of the host to the tumor is lymphocyte dependent. However, the effect of lymphocytes on chemotherapy prognosis is unknown. In this study, we investigated the correlation between pre-chemotherapeutic lymphocyte counts and the clinical characteristics of urothelial carcinoma and determined the effectiveness of lymphocytes as a prognostic predictor for metastatic urothelial carcinoma treated with chemotherapy. Between April 2003 and March 2011, data from 34 patients with unresectable or metastatic urothelial carcinoma were retrospectively subjected to multivariate regression analysis to determine the patient characteristics with independent prognostic significance for survival. The median patient age was 71 ; 21 patients were male and 13 female. The number of primary tumors in the pelvis, ureter, and bladder were four, six, and 24, respectively. Seventeen patients underwent prior curative resections, and visceral metastases at chemotherapy were detected in 14 patients. The median lymphocyte count at chemotherapy was 1,292/ml. Cancer-specific survival was significantly lower in patients with lymphocyte counts ＜1,000/ml than in patients with lymphocyte counts ≥1,000/μl (p＝0. 001). During multivariate analysis, visceral metastasis and lymphocyte counts were independent factors for predicting poor prognosis. In addition, lymphocyte counts of ＜1, 000/ml or positive visceral metastases also affected survival. This information may be useful for identifying patients who are likely to benefit from chemotherapy.
评估晚期尿路上皮癌患者预后的化疗前因素尚未完全明确。宿主对肿瘤的免疫反应依赖淋巴细胞。然而，淋巴细胞对化疗预后的影响尚不清楚。在本研究中，我们调查了化疗前淋巴细胞计数与尿路上皮癌临床特征之间的相关性，并确定淋巴细胞作为化疗转移性尿路上皮癌预后预测指标的有效性。在2003年4月至2011年3月期间，对34例不可切除或转移性尿路上皮癌患者的数据进行回顾性多因素回归分析，以确定对生存具有独立预后意义的患者特征。患者中位年龄为71岁；男性21例，女性13例。盆腔、输尿管和膀胱的原发肿瘤数量分别为4例、6例和24例。17例患者曾接受过根治性切除术，14例患者在化疗时检测到内脏转移。化疗时淋巴细胞计数的中位数为1292/ml。淋巴细胞计数＜1000/ml的患者癌症特异性生存率显著低于淋巴细胞计数≥1000/μl的患者（p = 0.001）。在多因素分析中，内脏转移和淋巴细胞计数是预测预后不良的独立因素。此外，淋巴细胞计数＜1000/ml或内脏转移阳性也会影响生存。这些信息可能有助于识别可能从化疗中获益的患者。
