Division of Nephrology and Kidney Institute, China Medical University and Hospitals, Taichung, Taiwan.
Division of Nephrology, Asia University Hospital, Taichung, Taiwan.
Sci Rep. 2019 Mar 5;9(1):3473. doi: 10.1038/s41598-019-40276-4.
Urothelial cancer (UC) is a common kidney cancer in Taiwan and patients with chronic kidney disease (CKD) are more at risk for UC than the general population. The diagnostic value of urine analysis and urine cytology is limited, especially in CKD patients. The aim of the study is to develop a nomogram to predict the risk of UC in CKD patients. We enrolled 169 UC patients and 1383 CKD patients from 9 hospitals in Taiwan between 2012 and 2015. CA125, HE4, clinical characteristics, and medical history were analyzed using multivariable logistic regression for its association with UC. A nomogram was developed to predict the risk of UC and was validated using Bootstrap. CA125 was associated with UC in CKD patients (OR: 5.91, 95% CI: 3.24-10.77) but HE4 was not (OR: 1.29, 95% CI: 0.67-2.35). A nomogram based on patients' age, estimated glomerular filtration rate, CA125 (log transformed), smoking, exposure of environmental toxin, use of nonsteroid anti-inflammatory drugs, and use of traditional Chinese medicine was conducted. The AUC of the nomogram was 0.90 (95% CI: 0.86-0.92, p < 0.01). Serum CA125 may identify UC patients from CKD patients but has limited diagnostic value due to low sensitivity. The diagnostic value of serum CA125 level can be improved by the combination with clinical characteristics including age, renal function, and medical history.
在台湾，尿路上皮癌（UC）是一种常见的肾癌，患有慢性肾脏病（CKD）的患者比一般人群更容易患 UC。尿液分析和尿液细胞学的诊断价值有限，尤其是在 CKD 患者中。本研究旨在开发一种列线图来预测 CKD 患者患 UC 的风险。我们招募了 2012 年至 2015 年间台湾 9 家医院的 169 名 UC 患者和 1383 名 CKD 患者。使用多变量逻辑回归分析 CA125、HE4、临床特征和病史与 UC 的相关性。使用 Bootstrap 验证开发了一种预测 UC 风险的列线图。CA125 与 CKD 患者的 UC 相关（OR：5.91，95%CI：3.24-10.77），但 HE4 与 UC 不相关（OR：1.29，95%CI：0.67-2.35）。基于患者年龄、估算肾小球滤过率、CA125（对数转换）、吸烟、暴露于环境毒素、使用非甾体抗炎药和使用中药，建立了一个列线图。该列线图的 AUC 为 0.90（95%CI：0.86-0.92，p<0.01）。血清 CA125 可识别 CKD 患者中的 UC 患者，但由于敏感性低，其诊断价值有限。通过结合年龄、肾功能和病史等临床特征，可以提高血清 CA125 水平的诊断价值。
