术前脓尿可预测膀胱肿瘤患者是否存在高级别膀胱癌。
Preoperative pyuria predicts the presence of high-grade bladder carcinoma in patients with bladder tumors.
作者信息
Poletajew Sławomir, Gajewska Dominika, Kaczmarek Krystian, Krajewski Wojciech, Łykowski Marcin, Sondka-Migdalska Joanna, Borowik Michał, Buraczyński Paweł, Dzięgała Mateusz, Przudzik Maciej, Słojewski Marcin, Kryst Piotr
机构信息
Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland.
Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland.
出版信息
Cent European J Urol. 2020;73(4):423-436. doi: 10.5173/ceju.2020.0289. Epub 2020 Dec 3.
INTRODUCTION
Preoperative identification of high-grade bladder cancer presence can optimize patient management. The aim of this study was to assess the association between preoperative pyuria and the pathological features of bladder cancer.
MATERIAL AND METHODS
This retrospective analysis enrolled 943 patients undergoing transurethral resection of a bladder tumor. Patients were divided into two study groups based on the presence of pyuria in preoperative urine analysis, defined as the presence of >5 leukocytes in the high power field. Pyuria status as a potential predictive factor was then confronted with pathological features based on standard microscopic examination of the surgical specimen.
RESULTS
Among 943 recruited patients, 294 (31.2%) presented with pyuria. Patients with pyuria were older (71 vs. 68 years, p <0.05), had higher rates of large (≥3 cm) tumors (37% vs. 26%, p <0.05), and more frequently presented concomitant hematuria (58% vs. 24%, p <0.05). In case of recurrent tumors patients with pyuria more often received intravesical chemotherapy in the past (4.8% vs. 1.4%, p <0.05). Regarding oncological data, patients with pyuria had significantly higher tumor stage and grade. On multivariable analysis pyuria was independently associated with high-grade tumors (OR 1.97, 95% CI 1.45-2.67). Specificity and negative predictive value of pyuria as a biomarker of high-grade tumors were 76% and 68%, respectively.
CONCLUSIONS
Preoperative pyuria can be regarded as a predictor of the presence of high-grade bladder carcinoma in patients with bladder tumors.
引言
术前识别高级别膀胱癌的存在可优化患者管理。本研究旨在评估术前脓尿与膀胱癌病理特征之间的关联。
材料与方法
本回顾性分析纳入了943例行膀胱肿瘤经尿道切除术的患者。根据术前尿液分析中是否存在脓尿将患者分为两个研究组，脓尿定义为高倍视野下白细胞>5个。然后将脓尿状态作为潜在预测因素与基于手术标本标准显微镜检查的病理特征进行对比。
结果
在943例纳入患者中，294例（31.2%）存在脓尿。有脓尿的患者年龄更大（71岁对68岁，p<0.05），大肿瘤（≥3 cm）发生率更高（37%对26%，p<0.05），且更常伴有血尿（58%对24%，p<0.05）。对于复发性肿瘤患者，有脓尿的患者过去更常接受膀胱内化疗（4.8%对1.4%，p<0.05）。关于肿瘤学数据，有脓尿的患者肿瘤分期和分级明显更高。多变量分析显示脓尿与高级别肿瘤独立相关（OR 1.97，95%CI 1.45 - 2.67）。脓尿作为高级别肿瘤生物标志物的特异性和阴性预测值分别为76%和68%。
结论
术前脓尿可被视为膀胱肿瘤患者高级别膀胱癌存在的预测指标。
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