慢性肾脏病作为原发性非肌层浸润性膀胱癌患者复发和病情进展的一个危险因素。

Chronic kidney disease as a risk factor for recurrence and progression in patients with primary non-muscle-invasive bladder cancer.

作者信息

Kobatake Kohei, Hayashi Tetsutaro, Black Peter C, Goto Keisuke, Sentani Kazuhiro, Kaneko Mayumi, Yasui Wataru, Mita Koji, Teishima Jun, Matsubara Akio

机构信息

Department of Urology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

The Vancouver Prostate Center and Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

出版信息

Int J Urol. 2017 Aug;24(8):594-600. doi: 10.1111/iju.13389. Epub 2017 Jul 22.

DOI:10.1111/iju.13389

PMID:28734027

Abstract

OBJECTIVES

To investigate the relationship between chronic kidney disease and primary non-muscle-invasive bladder cancer.

METHODS

Disease outcomes were analyzed in 418 patients treated with transurethral resection for primary non-muscle-invasive bladder cancer, and were correlated to traditional risk factors as well as chronic kidney disease stage according to estimated glomerular filtration rate: ≥60 (G1-2), 45-59 (G3a) or <45 (G3b-5).

RESULTS

The median follow-up time was 40.0 months. There were 287 (68.7%), 98 (23.4%), and 33 (7.9%) patients with G1-2, G3a and G3b-5 chronic kidney disease, respectively. T1 tumor was present in 29.6% of G1-2, 43.9% of G3a and 51.4% of G3b-5 chronic kidney disease (P = 0.004). The proportion of histological grade 3 non-muscle-invasive bladder cancer was higher in G3a and G3b-5 than G1-2 (P < 0.001). Higher chronic kidney disease stage was associated with worse recurrence-free (P < 0.001) and progression-free survival (P = 0.017). In multivariable analysis, G3b-5 was found to be an independent predictor for recurrence (hazard ratio 1.87; P = 0.004) and progression (hazard ratio 2.96; P = 0.019). Chronic kidney disease stage was also strongly associated with the European Association of Urology bladder cancer risk groups (P < 0.001), and with shorter time to recurrence and progression in each group.

CONCLUSIONS

Chronic kidney disease predicts the clinical outcome of primary non-muscle-invasive bladder cancer. Adding chronic kidney disease to the conventional risk factors might increase the accuracy of risk stratification.

摘要

目的

探讨慢性肾脏病与原发性非肌层浸润性膀胱癌之间的关系。

方法

对418例接受经尿道切除术治疗原发性非肌层浸润性膀胱癌的患者的疾病转归进行分析，并将其与传统危险因素以及根据估计肾小球滤过率划分的慢性肾脏病分期相关联：≥60（G1-2）、45-59（G3a）或<45（G3b-5）。

结果

中位随访时间为40.0个月。分别有287例（68.7%）、98例（23.4%）和33例（7.9%）患者患有G1-2、G3a和G3b-5期慢性肾脏病。G1-2期慢性肾脏病患者中T1期肿瘤占29.6%，G3a期为43.9%，G3b-5期为51.4%（P = 0.004）。G3a期和G3b-5期非肌层浸润性膀胱癌的组织学3级比例高于G1-2期（P < 0.001）。慢性肾脏病分期越高，无复发生存率（P < 0.001）和无进展生存率（P = 0.017）越差。在多变量分析中，发现G3b-5期是复发（风险比1.87；P = 0.004）和进展（风险比2.96；P = 0.019）的独立预测因素。慢性肾脏病分期也与欧洲泌尿外科学会膀胱癌风险组密切相关（P < 0.001），并且与每组中复发和进展的时间缩短有关。