Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Ann Surg Oncol. 2018 Apr;25(4):1086-1093. doi: 10.1245/s10434-017-6295-3. Epub 2018 Jan 12.
The relation of dialysis to tumor recurrence in patients with upper tract urothelial cancer (UTUC) is unknown; however, a limited number of small-scale studies suggest that patients with renal diseases prior to UTUC are more likely to exhibit bladder recurrence. We performed a population-based analysis to determine the effect of dialysis on bladder recurrence for patients with UTUC.
This retrospective cohort study included patients diagnosed with UTUC (2002-2007) from the Taiwan National Cancer Registry and divided them into two groups-dialysis and non-dialysis groups. These patients were followed up until bladder recurrence, death, or the end of 2010. Competing risk analyses adjusting covariates and death were applied to determine the relation of dialysis and bladder recurrence.
Of the 5141 eligible patients, 548 (10.7%) were undergoing dialysis. The cumulative bladder recurrence was significantly higher in the dialysis group than in the non-dialysis group (29% vs. 21%, modified log-rank p < 0.001). In the multivariable analysis, the dialysis group exhibited a 64% increased bladder recurrence risk (cause-specific hazard ratio 1.64, 95% confidence interval 1.34-2.01, p < 0.001), which was confirmed using stratification and propensity score weighting methods. The other prognostic factors for bladder recurrence were sex, diabetes, cardiac disorder, Charlson Comorbidity Index, and tumor grade.
Despite unknown reasons, approximately one-tenth of patients with UTUC have experienced dialysis treatment. Patients undergoing dialysis have a higher risk of bladder recurrence. Various treatment and screening strategies should be developed for dialysis and non-dialysis patients.
透析与上尿路尿路上皮癌（UTUC）患者肿瘤复发的关系尚不清楚；然而，少数小规模研究表明，UTUC 前患有肾脏疾病的患者更有可能出现膀胱复发。我们进行了一项基于人群的分析，以确定透析对 UTUC 患者膀胱复发的影响。
本回顾性队列研究纳入了台湾国家癌症登记处诊断为 UTUC（2002-2007 年）的患者，并将其分为透析组和非透析组。这些患者随访至膀胱复发、死亡或 2010 年底。应用调整协变量和死亡的竞争风险分析来确定透析与膀胱复发的关系。
在 5141 名合格患者中，有 548 名（10.7%）正在接受透析。透析组的累积膀胱复发率明显高于非透析组（29%比 21%，修正对数秩检验 p<0.001）。多变量分析显示，透析组膀胱复发风险增加 64%（特异性病因危险比 1.64，95%置信区间 1.34-2.01，p<0.001），这一结果通过分层和倾向评分加权方法得到了证实。膀胱复发的其他预后因素包括性别、糖尿病、心脏疾病、Charlson 合并症指数和肿瘤分级。
尽管原因不明，但约十分之一的 UTUC 患者接受了透析治疗。接受透析的患者膀胱复发的风险更高。应针对透析和非透析患者制定各种治疗和筛查策略。
