Ramirez Daniel, Gupta Amit, Canter Daniel, Harrow Brian, Dobbs Ryan W, Kucherov Victor, Mueller Edward, Streeper Necole, Uhlman Matthew A, Svatek Robert S, Messing Edward M, Lotan Yair
Department of Urology, University of Texas (UT) Southwestern Medical Center, Dallas, TX, USA.
University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
BJU Int. 2016 May;117(5):783-6. doi: 10.1111/bju.13345. Epub 2015 Oct 29.
To determine whether the severity of haematuria (microscopic or gross) at diagnosis influences the disease stage at presentation in patients diagnosed with bladder cancer.
We conducted a multi-institutional observational cohort study of patients who were newly diagnosed with bladder cancer between August 1999 and May 2012. We reviewed the degree of haematuria, demographic information, clinical and social history, imaging, and pathology. The association of haematuria severity with incident tumour stage and grade was evaluated using logistic regression.
Patients diagnosed with bladder cancer presented with gross haematuria (GH; 1 083, 78.3%), microscopic haematuria (MH; 189, 13.7%) or without haematuria (112, 8.1%). High-grade disease was found in 64% and 57.1% of patients presenting with GH and MH, respectively, and severity of haematuria was not associated with higher grade disease. Stage of disease at diagnosis for patients presenting with MH was Ta/carcinoma in situ (CIS) in 68.8%, T1 in 19.6%, and ≥T2 in 11.6%. Stage of disease at diagnosis for patients presenting with GH was Ta/CIS in 55.9%, T1 in 19.6%, and ≥T2 in 17.9%. On multivariate analyses, GH was independently associated with ≥T2 disease at diagnosis (odds ratio 1.69, 95% confidence interval 1.05-2.71, P = 0.03).
Among patients with newly diagnosed bladder cancer, presentation with GH is associated with a more advanced pathological stage. Earlier detection of disease, before development of GH, could influence survival in patients with bladder cancer. Type of haematuria at presentation does not impact grade of disease.
确定诊断时血尿（镜下或肉眼血尿）的严重程度是否会影响膀胱癌患者确诊时的疾病分期。
我们对1999年8月至2012年5月期间新诊断为膀胱癌的患者进行了一项多机构观察性队列研究。我们回顾了血尿程度、人口统计学信息、临床和社会病史、影像学及病理学资料。采用逻辑回归评估血尿严重程度与肿瘤分期及分级的相关性。
诊断为膀胱癌的患者中，出现肉眼血尿（GH；1083例，78.3%）、镜下血尿（MH；189例，13.7%）或无血尿（112例，8.1%）。分别有64%和57.1%的出现GH和MH的患者为高级别疾病，但血尿严重程度与高级别疾病无关。出现MH的患者确诊时疾病分期为Ta/原位癌（CIS）的占68.8%，T1期的占19.6%，≥T2期的占11.6%。出现GH的患者确诊时疾病分期为Ta/CIS的占55.9%，T1期的占19.6%，≥T2期的占17.9%。多因素分析显示，GH与确诊时≥T2期疾病独立相关（比值比1.69，95%置信区间1.05 - 2.71，P = 0.03）。
在新诊断的膀胱癌患者中，出现GH与更晚期的病理分期相关。在GH出现之前更早地发现疾病可能会影响膀胱癌患者的生存。确诊时血尿类型不影响疾病分级。
