Yoshida Takashi, Kinoshita Hidefumi, Shimada Seiji, Sugi Motohiko, Matsuda Tadashi
Department of Urology and Andrology, Kori Hospital, Kansai Medical University, Osaka, Japan; Department of Urology and Andrology, Kansai Medical University Hospital, Osaka, Japan.
Department of Urology and Andrology, Kansai Medical University Hospital, Osaka, Japan.
Clin Genitourin Cancer. 2017 Aug;15(4):e543-e550. doi: 10.1016/j.clgc.2016.12.021. Epub 2016 Dec 29.
The purpose of this study was to determine the prognostic significance of preoperative pyuria in patients with upper urinary tract urothelial carcinoma after surgery.
We retrospectively evaluated data on 157 patients with nonmetastatic upper urinary tract urothelial carcinoma who had undergone surgery at our institution. The associations between clinical features and advanced pathological findings were evaluated using a logistic regression model. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were assessed with the Kaplan-Meier method and Cox regression analysis. The influence of pyuria on the predictive accuracy of the multivariate model was assessed using the concordance index.
The median postoperative follow-up among patients who survived was 48.1 months. Preoperative pyuria was significantly correlated with worse RFS, CSS, and OS (P < .001 each). Pyuria was also associated with significantly increased risk of a high pathological T stage (≥ pT3; odds ratio, 2.99; P = .003), high tumor Grade (G3; odds ratio, 2.25; P = .038), and lymphovascular invasion (odds ratio, 2.25; P = .008). Moreover, multivariate Cox regression analyses showed that pyuria was an independent prognostic factor for RFS (hazard ratio, 3.02; P < .001), CSS (hazard ratio, 2.15; P = .043), and OS (hazard ratio, 2.10; P = .019). For CSS, the addition of pyuria to the multivariate model increased its predictive accuracy from 0.87 to 0.90.
Preoperative pyuria is significantly associated with CSS, OS, and increased risk of locally advanced disease and subsequent disease recurrence in patients with upper urinary tract urothelial carcinoma who undergo surgery.
本研究的目的是确定术前脓尿对上尿路尿路上皮癌患者术后预后的意义。
我们回顾性评估了在我院接受手术的157例非转移性上尿路尿路上皮癌患者的数据。使用逻辑回归模型评估临床特征与高级别病理结果之间的关联。采用Kaplan-Meier法和Cox回归分析评估无复发生存期（RFS）、癌症特异性生存期（CSS）和总生存期（OS）。使用一致性指数评估脓尿对多变量模型预测准确性的影响。
存活患者的术后中位随访时间为48.1个月。术前脓尿与较差的RFS、CSS和OS显著相关（每项P <.001）。脓尿还与高病理T分期（≥ pT3；比值比，2.99；P =.003）、高肿瘤分级（G3；比值比，2.25；P =.038）和淋巴管浸润（比值比，2.25；P =.008）的风险显著增加相关。此外，多变量Cox回归分析显示，脓尿是RFS（风险比，3.02；P <.001）、CSS（风险比，2.15；P =.043）和OS（风险比，2.10；P =.019）的独立预后因素。对于CSS，将脓尿添加到多变量模型中可将其预测准确性从0.87提高到0.90。
术前脓尿与接受手术的上尿路尿路上皮癌患者的CSS、OS以及局部晚期疾病和随后疾病复发风险增加显著相关。
