Division of Urology, Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Pediatric Urology, Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee.
Department of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; Children's Foundation Research Institute, Memphis, Tennessee.
J Urol. 2016 Apr;195(4 Pt 2):1312-7. doi: 10.1016/j.juro.2015.11.035. Epub 2016 Feb 28.
Hemorrhagic cystitis is a complication of treatment of pediatric cancer with considerable variation in severity and morbidity. This study presents an analysis of hemorrhagic cystitis severity and treatment outcomes in a large pediatric population.
Patients with hemorrhagic cystitis treated at St. Jude Children's Research Hospital® were identified from 1990 to 2010. Demographic data were gathered along with information pertaining to initial primary diagnosis, hemorrhagic cystitis diagnosis and treatment, and mortality. Statistical analyses were performed to evaluate associations between risk factors and severity of hemorrhagic cystitis as well as treatment outcomes.
Of the 285 patients who met inclusion criteria 54% were male. Mean age was 11.41 years. Mean time from initial primary diagnosis to hemorrhagic cystitis onset was 29 months. Noninvasive treatment was performed in 246 patients (86%) and operative intervention was required in 14 (4.9%). Bivariate analysis demonstrated that pelvic radiation therapy (p = 0.0002), any radiation therapy (p = 0.005), acute lymphocytic leukemia (p = 0.01), bone marrow transplantation (p = 0.0225), cyclophosphamide exposure (p = 0.0419) and BK virus positivity (p = 0.0472) were predictors of higher grade hemorrhagic cystitis. Factors correlating with the need for invasive management on bivariate analysis included pelvic radiation therapy (p = 0.0266), bone marrow transplantation (p = 0.0007), hematological malignancy (p = 0.0066), ifosfamide exposure (p = 0.0441) and male gender (p = 0.0383). Multivariate analysis showed independent effects of pelvic radiation therapy (p = 0.001) and delayed onset of hemorrhagic cystitis (p = 0.0444).
Severity of hemorrhagic cystitis and failure of noninvasive management correlate with several identifiable risk factors. Prospective identification of patients with these risk factors may allow for targeted early intervention in those at highest risk.
儿童癌症治疗后出现血尿性膀胱炎是一种并发症，其严重程度和发病率差异较大。本研究对大量儿科人群的血尿性膀胱炎严重程度和治疗结果进行了分析。
1990 年至 2010 年，在圣裘德儿童研究医院®对接受治疗的血尿性膀胱炎患儿进行了鉴定。收集了人口统计学数据，以及与初始原发性诊断、血尿性膀胱炎诊断和治疗以及死亡率相关的信息。为了评估危险因素与血尿性膀胱炎严重程度以及治疗结果之间的关系，进行了统计学分析。
符合纳入标准的 285 例患者中，54%为男性。平均年龄为 11.41 岁。从初始原发性诊断到血尿性膀胱炎发作的平均时间为 29 个月。246 例（86%）接受了非侵入性治疗，14 例（4.9%）需要手术干预。双变量分析表明，盆腔放疗（p = 0.0002）、任何放疗（p = 0.005）、急性淋巴细胞白血病（p = 0.01）、骨髓移植（p = 0.0225）、环磷酰胺暴露（p = 0.0419）和 BK 病毒阳性（p = 0.0472）是血尿性膀胱炎更严重的预测因素。双变量分析中与侵袭性治疗需求相关的因素包括盆腔放疗（p = 0.0266）、骨髓移植（p = 0.0007）、血液恶性肿瘤（p = 0.0066）、异环磷酰胺暴露（p = 0.0441）和男性（p = 0.0383）。多变量分析显示盆腔放疗（p = 0.001）和血尿性膀胱炎延迟发作（p = 0.0444）有独立影响。
血尿性膀胱炎的严重程度和非侵入性治疗失败与几个可识别的危险因素相关。对具有这些危险因素的患者进行前瞻性识别，可能有助于对高危患者进行早期有针对性的干预。
