术前贫血对上尿路尿路上皮癌患者尿路上皮和非尿路上皮复发的预后影响
Prognostic Impact of Preoperative Anemia on Urothelial and Extraurothelial Recurrence in Patients With Upper Tract Urothelial Carcinoma.
作者信息
Milojevic Bogomir, Dzamic Zoran, Kajmakovic Boris, Durutovic Otas, Bumbasirevic Uros, Sipetic Grujicic Sandra
机构信息
Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.
Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.
出版信息
Clin Genitourin Cancer. 2015 Oct;13(5):485-91. doi: 10.1016/j.clgc.2015.03.007. Epub 2015 Mar 30.
BACKGROUND
To investigate the prognostic impact of preoperative anemia on urothelial and extraurothelial recurrence after radical nephroureterectomy.
METHODS
A single-center series of 238 consecutive patients who were treated with radical nephroureterectomy for upper tract urothelial carcinoma was evaluated. We categorized patients on the basis of hemoglobin level into 2 groups, including normal or anemia. Survival was estimated using the Kaplan-Meier method. Cox proportional hazard regression models were used to evaluate the association of preoperative anemia with outcome, controlling for clinicopathologic variables.
RESULTS
Ninety-seven patients (40.8%) had anemia (median hemoglobin level, 143 vs. 107 g/L). Preoperative anemia was associated with history of bladder cancer (P = .01), tumor multifocality (P = .03), lymphovascular invasion (P = .05), and adjuvant chemotherapy (P = .01). Higher tumor stage and grade, and lymph node metastasis were significantly associated with preoperative anemia. Preoperative anemia was independently associated with extraurothelial recurrence (hazard ratio, 1.95; 95% confidence interval, 1.14-3.34; P = .01) in multivariate Cox regression analyses. Only a history of bladder tumor (hazard ratio, 2.07; P = .009) and tumor multifocality (hazard ratio, 3.97; 95% confidence interval, 2.37-6.67; P < .001) were independently associated with urothelial recurrence. The 5-year cancer-specific survival for patients with normal hemoglobin level was 82.1% and for patients with preoperative anemia was 54.2%.
CONCLUSION
Patients with preoperative anemia had a greater probability of having upper tract urothelial carcinoma with higher tumor stages, higher tumor grades, and lymph node metastasis (pN+). Preoperative anemia was statistically significantly associated with worse cancer-specific survival and extraurothelial recurrence in patients who underwent radical nephroureterectomy.
背景
探讨术前贫血对根治性肾输尿管切除术后尿路上皮和尿路上皮外复发的预后影响。
方法
对单中心连续238例因上尿路尿路上皮癌接受根治性肾输尿管切除术的患者进行评估。我们根据血红蛋白水平将患者分为两组，即正常组或贫血组。采用Kaplan-Meier法估计生存率。使用Cox比例风险回归模型评估术前贫血与预后的关联，并对临床病理变量进行控制。
结果
97例患者（40.8%）患有贫血（血红蛋白水平中位数，143 vs. 107 g/L）。术前贫血与膀胱癌病史（P = 0.01）、肿瘤多灶性（P = 0.03）、淋巴管浸润（P = 0.05）及辅助化疗（P = 0.01）相关。更高的肿瘤分期和分级以及淋巴结转移与术前贫血显著相关。在多因素Cox回归分析中，术前贫血与尿路上皮外复发独立相关（风险比，1.95；95%置信区间，1.14 - 3.34；P = 0.01）。只有膀胱肿瘤病史（风险比，2.07；P = 0.009）和肿瘤多灶性（风险比，3.97；95%置信区间，2.37 - 6.67；P < 0.001）与尿路上皮复发独立相关。血红蛋白水平正常患者的5年癌症特异性生存率为82.1%，术前贫血患者为54.2%。
结论
术前贫血患者发生上尿路尿路上皮癌且肿瘤分期更高、肿瘤分级更高和淋巴结转移（pN+）的可能性更大。术前贫血与接受根治性肾输尿管切除术患者较差的癌症特异性生存率和尿路上皮外复发在统计学上显著相关。
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