Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan.
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan.
J Formos Med Assoc. 2022 Nov;121(11):2182-2190. doi: 10.1016/j.jfma.2022.03.012. Epub 2022 Mar 31.
BACKGROUND/PURPOSE: Upper tract urothelial carcinoma (UTUC) is a relatively rare type of urothelial carcinoma. Additionally, only few reports have examined the sex differences in patients with UTUC. Therefore, the present study aimed to identify the sex factors affecting renal function in patients with UTUC who underwent radical nephroureterectomy (RNU).
Patients who underwent RNU for non-metastatic UTUC between 2000 and 2013 were retrospectively reviewed and divided into two groups by sex. The Kaplan-Meier method was applied to evaluate the effects of sex on survival, whereas for the other clinicopathological parameters, hazard ratios were evaluated using the Cox regression model. The analyses were also performed in patients with different chronic kidney disease (CKD) stages.
A total of 368 patients were included, 147 men and 221 women. Female patients had a higher rate of anemia, advanced CKD stage, and dialysis. Male patients predominantly had a higher rate of smoking. The Kaplan-Meier analysis revealed no differences between sexes on recurrence-free survival (RFS) and cancer-specific survival (CSS). Multivariate analysis confirmed that ureteral tumors, advanced pathological tumor stage, and adjuvant chemotherapy indicated significantly worse survival outcomes in both sexes. However, only female patients with advanced CKD showed poorer RFS. After adjusting for renal function, the analysis found men had worse RFS.
The female sex is significantly associated with a higher prevalence of advanced CKD stage, and dialysis among patients with UTUC who underwent RNU in our institute. Sex differences in renal function needs to be considered when evaluating survival.
背景/目的：上尿路尿路上皮癌（UTUC）是一种相对罕见的尿路上皮癌。此外，仅有少数报告研究了 UTUC 患者的性别差异。因此，本研究旨在确定影响接受根治性肾输尿管切除术（RNU）的 UTUC 患者肾功能的性别因素。
回顾性分析 2000 年至 2013 年间接受 RNU 治疗的非转移性 UTUC 患者，并按性别分为两组。应用 Kaplan-Meier 法评估性别对生存的影响，而对于其他临床病理参数，则使用 Cox 回归模型评估风险比。还在不同慢性肾脏病（CKD）分期的患者中进行了分析。
共纳入 368 例患者，其中男性 147 例，女性 221 例。女性患者贫血、晚期 CKD 分期和透析的发生率较高。男性患者吸烟的比例较高。Kaplan-Meier 分析显示，两组患者在无复发生存率（RFS）和癌症特异性生存率（CSS）方面无差异。多变量分析证实，输尿管肿瘤、晚期病理肿瘤分期和辅助化疗在两性中均预示着生存结局较差。然而，仅女性晚期 CKD 患者的 RFS 较差。在调整肾功能后，分析发现男性 RFS 较差。
本研究中，女性在我院接受 RNU 的 UTUC 患者中，CKD 晚期和透析的患病率显著较高，与性别相关。在评估生存时，需要考虑肾功能的性别差异。
